Massage therapy is a treatment option which can reduce pain and discomfort in the soft tissue surrounding a fracture injury, and it can also assist in reducing edema and muscle tension of both the affected and compensating structures. When a massage therapy treatment plan is carried out correctly, once the cast is removed, a client can regain full function sooner as the health and mobility of compensating muscles has been addressed.
Initially, your massage therapist will only work above the cast, and will take care to not disturb the healing bone. Eventually, when the cast is removed, massage therapy will continue to restore the health of the tissue by increasing circulation, restoring function and strength, and reducing any scar tissue.
Considerations for treatment
It is highly recommended that your physician provide a written recommendation for massage, and your therapist probably won’t agree to treat you until your doctor has given the green light.
In all likelihood, you will also be seeing a physical (physio) therapist. It’s a good idea to provide written permission for your massage therapist to collaborate with your other health care professionals to ensure the best possible care and treatment outcome.
Before your massage therapist begins to treat you, he or she will want to verify the following information:
- your physician has approved massage therapy
- are you on any type of medication? (anti-inflammatory, analgesic, anti-coagulant, antibiotics).
- what is your general health – for example, consider age, fitness prior to injury, nutrition (your MT may refer you to a nutritionist, as proper nutrition impacts the healing process), lifestyle (i.e. do you smoke?)
- are there any open wounds which must be addressed? (i.e. with a compound fracture)
- Will treating the affected limb with massage therapy stress and disrupt the healing of bone, muscle, skin or nerve tissue?
- is there any neurological or vascular impairment in the area which prevents the use of certain massage techniques or modalities?
- do you have any plates, wires or pins? If so, hydrotherapy over the site will be contraindicated.
- the most important consideration is to avoid stressing and interfering with healing tissue. Any pressure or traction applied to the affected bone is contraindicated.
- have other types of injuries been sustained, such as sprains or contusions? (in all likelihood, there will be other injuries)
- muscle atrophy from disuse will be present when the cast is removed. Provided that the injury is not an avulsion fracture, the development of atrophy can be reduced by the use of isometric contractions at the appropriate time with cast on. If an avulsion fracture is present, avoid isometric contractions, as this may disrupt the healing bone.
- tissue under the cast will be fragile when the cast is removed, so extra care must be taken when massaging this tissue
As treatment progresses and the injury heals, issues such as tissue atrophy, altered biomechanics and altered proprioception must be taken into account. For this reason, there are different considerations for treatment with cast on and cast off.
Types of fractures
There are several basic types of fractures:
1. Simple – there is no broken skin, and the break is clean. Also known as a “closed” fracture.
2. Compound – the broken bone damages surrounding tissue and skin by piercing it. There is a greater risk of infection in this type of break due to breaking of the skin and protrusion of the injured bone.
3. Comminuted – a fracture that is in several pieces – common among a population with more brittle bones (i.e. elderly)
4. Compression – a fracture where the bone is crushed
5. Depression – a fracture where the bone is crushed and pressed inward
6. Impacted – bony surfaces are forced into each other (impacted)
7. Spiral – an break with ragged edges that result from twisting
8. Greenstick – an incomplete break that is common in children, as bones are more flexible
9. Stress fracture – a.k.a. hairline fracture, is a tiny crack in the bone and may not be visible with an x-ray
10. Avulsion – this occurs when a ligament or tendon pulls away a chunk of bone to which it is attached.
Fractures and breaks are repaired by “reduction” – when the bony ends are placed back together. A closed reduction is done manually by a physician, whereas an open reduction involves surgery, and possibly the placement of pins or wires to hold the bony surfaces together.
Finding the best massage therapist for you
It goes without saying that an injury as serious as a fracture or break will require treatment from a therapist who really knows his or her stuff and understands the healing process. Personally, I would ask my physical therapist if he or she could refer me to a qualified and experienced massage therapist, and then ensure that I give them both permission to communicate with each other so that my treatment plan would address all of my needs and concerns.