Crush trauma/nerve damage - warning, a little graphic

[Rottie Momma]

I have a pair of patients who were in a farm accident - a giant piece of farm equipment fell on about 10 workers, trapping them all by the legs for about a half hour. It was bad - several of the workers had broken legs, though not my patients. The accident was nearly 6 months ago. My patients started coming to me twice a week, 4 weeks ago.

They both still have exquisite tenderness over every surface of their bodies -- as if they had trauma-induced chronic pain. Walking is difficult for both, although a little easier for the younger patient. Both experience v. cold feet when still, then burning pain in soles of BL feet after walking more than 10 minutes. Both still have jumpy little spasms throughout their backs and legs. Neither has been able to return to any kind of work. Their sleep is v. poor. They are totally traumatized still, and tearful during some of their sessions. Sessions are only painful for them still, no matter what kind of pressure, holds, or strokes I've tried.

I need to step up my game to help these patients better. But I am a little at a loss about what direction to step. I'd like to see calmed spasms, pain relief during the session and for 4 hours afterward, and consistent 4-hour blocks of sleep. Help?

 

[dani]

Crush trauma/nerve damage - warning, a little graphic

Yes, their nervous systems are extremely delicate right now. You must be doing something right if your clients are returning for twice weekly appointments! I would just go very gently and with lots of patience, soothing work and nothing too jarring. No need to step up your game, your clients will heal when they are ready. Also, the older one gets, the longer the healing process.

If they aren't seeking psychological counseling for PTSD, I'd definitely recommend it.

 

[Vishak]

Crush trauma/nerve damage - warning, a little graphic

Hi BJP,
Do you do any Reiki at all? Sometimes it can really help on energetic and emotional levels as well as physical. Often the best you can do is hold a loving space while the body mends.

 

[Kala]

Crush trauma/nerve damage - warning, a little graphic

Both experience v. cold feet when still, then burning pain in soles of BL feet after walking

This sounds like they both have Raynaud's phenomenon because of the accident, so take very special care of their hand and feet because they may have a loss of sensation and not even know it.

In these types of cases I tend to stick with lighter work the nervous system is already in over drive. I tend to favor CST and like Kathryn said the fact they are coming to you twice a week means that they feel very confident in your work.

 

[sciencegeek+]

Crush trauma/nerve damage - warning, a little graphic

Raynaud's phenomenon because of the accident...

It is my understanding that Raynaud's phenomenon usually occurs due to the vessels constricting with cold and not from a traumatic event. If you find documentation that it can occur only due to trauma, would you be kind enough to post the link here, as I would love to have it for future reference.

You may be thinking of RSD (Reflex Sympathetic Dystrophy) which some people call Complex Regional Pain Syndrome (CRPS). Although, I am not even sure that this is the current issue with these particular clients. They would need a thorough work-up to be diagnosed properly.

I need to step up my game to help these patients better. But I am a little at a loss about what direction to step. I'd like to see calmed spasms, pain relief during the session and for 4 hours afterward, and consistent 4-hour blocks of sleep. Help?

Do you know a good acupuncturist you could refer them to? This may be a good synergistic application to what you are already doing. Possibly they could come see you twice a week and add an acupuncture session in... or see you once a week and the acupuncturist the other day.

Regardless, I think that 2x/week for 4 weeks, is not enough time for you to see the results you are hoping for, especially since the accident was 6 months ago. I would not start getting too stressed about "upping your game" (as I believe you are quite competent), until you've seen them for at least ten to twelve weeks. The nature of this kind of accident is very traumatic.

I second some mental bolstering (via a good psych professional).

And, last, I had a client years ago who was run over by a fork-lift. It took a long time (years) for him to heal. In the end he retained one leg/foot and lost the other foot. Your work will help, rather you see the results you are hoping for or not. They wouldn't be coming back at this rate, if you weren't providing them with a help they resonate with.

 

[in_lovebaby13]

Crush trauma/nerve damage - warning, a little graphic

Thanks for the advice and encouragement guys. t049

I don't think they would have chosen to come to us at all without prompting. Most of the work we do in our clinic is workers' comp cases, referred by an occupational medicine office. The docs there are the ones who have faith in our work, and they send us just about every soft-tissue injury they see, for a 12-session block; if the patient doesn't comply, their workers' comp funding is cut off, so compliance is high, even from the initially doubtful .

The trouble is, it is usually hard to get approval for more than 12 sessions. I am used to making my treatment plan work in that amount of time - getting people back to work. Occasionally we can get approval to give an add'l 6 sessions, and I think I will be able to for both of these patients -- but how much will I be able to do in that time? Any tips for helping them as quickly as possible, without being able to treat aggressively?

I mean, these patients feel they are faced with a huge choice. If they don't get well enough to go back to field work soon, they will have to move back to Mexico. They do not have the language, job skills, or education to just get some other type of work here at this time. It's a lot of pressure on them, and I just want to help as well as I can.

 

[MaqAtak]

Crush trauma/nerve damage - warning, a little graphic

If they can manage it seeing either an acupuncturist or a Jin Shin Jyutsu practitioner would also help greatly to both calm the nervous system & the mental/emotional trauma they've experienced. I could probably send you a couple of Jin Shin Jyutsu flows that would help, if you'd like, once we've gone over things further via email. Its very simple to perform as you are simply holding 2 points at a time, in a sequence. Usually it's based on the pulse & body readings we practitioners do - but considering the area of the injury & the circumstances I could come up with a few options for you to try.

While the cold feet can be labeled as Reynauds - it's also a sign that not only is there physical trauma, but trauma on the energetic levels. Do they still have signs of the injuries, such as visible swelling & bruising?

When I work with clients who have experienced a bad fall/impact to the body from something falling them, etc. I actually do a few different things - if you were to just slowly & quietly to run your hands down over their legs - just off the body ( one at a time - starting at the hips or the feet) you may be able to pick a subtle energy - similar to the static electricity of a TV screen) As the hands move you'll often find there is what I think of as a dead zone (this is where the energy is blocked up & cannot move down the front or up the back, etc. of the body) where there will not be any sense of energy there.

You may feel pain in your hands, if you're sensitive to picking up other people's pain/injury. They may feel a painful sensation too, even though you're not physically touching the area.

You can place one hand on the body (or keep it just off by an inch or two) just above "the dead zone" and place the other hand down below where the injury or pain seems to be & hold that hand placement for a few minutes. What happens at that point is that it seems to allow for a bridge (for want of a better term) to be made - allowing the energy to begin flowing again. They can also do this for themselves - with hands on, or even just by placing a thought or intention on the area of concern and visualizing the energy flowing freely, much like a creek, stream or river. It's as if the body needs to be reprogrammed, after a traumatic injury, to allow the process of healing to take place.


As mentioned PTSD is definitely likely, so while some emotional support is helpful the body work you're doing is also helping on many levels. Keep up the good work!

 

[coolPINKISH]

Crush trauma/nerve damage - warning, a little graphic

[ I think that 2x/week for 4 weeks, is not enough time for you to see the results you are hoping for, especially since the accident was 6 months ago. I would not start getting too stressed about "upping your game" (as I believe you are quite competent), until you've seen them for at least ten to twelve weeks. The nature of this kind of accident is very traumatic.

I cross-posted and wanted to make sure I acknowledge this - b/c I agree. I just want to make sure I don't miss something during the limited time I have for treating them, yanno?

I appreciate your whole post. CRPS is exactly what I was thinking of, thank you - I could not put my finger on the name.

I think I will mention an acupuncture referral when I review to their doc Monday. The referral has to come from her if workers' comp is to pay for it, but I do think WC will cover it if it's prescribed.

 

[Pompal 09.]

Crush trauma/nerve damage - warning, a little graphic

Raynaud's phenomenon because of the accident...

It is my understanding that Raynaud's phenomenon usually occurs due to the vessels constricting with cold and not from a traumatic event. If you find documentation that it can occur only due to trauma, would you be kind enough to post the link here, as I would love to have it for future reference.

http://cedars-sinai.edu/Patients/Health-Conditions/Raynauds-Phenomenon.aspx

Raynaud's Disease happens for no apparent reason, I have it. Where as Raynaud's phenomenon happens due to illness of injury.

 

[beckerman2013]

Crush trauma/nerve damage - warning, a little graphic

http://cedars-sinai.edu/Patients/Health-Conditions/Raynauds-Phenomenon.aspx

"When it occurs as part of another disease, it is called Raynaud's phenomenon (or secondary Raynaud's). This type usually affects either both hands or both feet. Causes may include scleroderma, lupus, rheumatoid arthritis, Sjögren's syndrome, diseases of the arteries, carpal tunnel syndrome, smoking, chemical exposure, certain drugs or injury."

Thanks for the link. Although I am not convinced the client has Raynaud's, it is certainly worth consideration.

 

[Maddy]

Crush trauma/nerve damage - warning, a little graphic

The trouble is, it is usually hard to get approval for more than 12 sessions. I am used to making my treatment plan work in that amount of time - getting people back to work. Occasionally we can get approval to give an add'l 6 sessions, and I think I will be able to for both of these patients -- but how much will I be able to do in that time? Any tips for helping them as quickly as possible, without being able to treat aggressively?

I hear your delimma. I am so sorry, but I don't have any other tips, except that you may want to see if you can get in touch directly with their Nurse Case Worker, or have them meet with an Ombudsman.

I have found that sometimes if you can actually speak with the Nurse Case Worker, you can get them on board, when they realize you actually care about the clients health and welfare. Unfortunately, many times they assume just the opposite.

 

[Jenx D]

Crush trauma/nerve damage - warning, a little graphic

I actually do a few different things - if you were to just slowly & quietly to run your hands down over their legs - just off the body ( one at a time - starting at the hips or the feet) you may be able to pick a subtle energy - similar to the static electricity of a TV screen) As the hands move you'll often find there is what I think of as a dead zone (this is where the energy is blocked up & cannot move down the front or up the back, etc. of the body) where there will not be any sense of energy there.

You may feel pain in your hands, if you're sensitive to picking up other people's pain/injury. They may feel a painful sensation too, even though you're not physically touching the area.

You can place one hand on the body (or keep it just off by an inch or two) just above "the dead zone" and place the other hand down below where the injury or pain seems to be & hold that hand placement for a few minutes. What happens at that point is that it seems to allow for a bridge (for want of a better term) to be made - allowing the energy to begin flowing again. They can also do this for themselves - with hands on, or even just by placing a thought or intention on the area of concern and visualizing the energy flowing freely, much like a creek, stream or river. It's as if the body needs to be reprogrammed, after a traumatic injury, to allow the process of healing to take place.

Nodding... and, sending you a PM regarding my personal experience in moving energy.

 

[Early Cuyler]

Crush trauma/nerve damage - warning, a little graphic

While the cold feet can be labeled as Reynauds - it's also a sign that not only is there physical trauma, but trauma on the energetic levels. Do they still have signs of the injuries, such as visible swelling & bruising?

Yes. There are still indentations in the shins from the impact (with small dark marks lingering), and constant low-level inflammation throughout BL lower limbs in both pts.

When I work with clients who have experienced a bad fall/impact to the body from something falling them, etc. I actually do a few different things - if you were to just slowly & quietly to run your hands down over their legs - just off the body ( one at a time - starting at the hips or the feet) you may be able to pick a subtle energy - similar to the static electricity of a TV screen) As the hands move you'll often find there is what I think of as a dead zone (this is where the energy is blocked up & cannot move down the front or up the back, etc. of the body) where there will not be any sense of energy there.

You can place one hand on the body (or keep it just off by an inch or two) just above "the dead zone" and place the other hand down below where the injury or pain seems to be & hold that hand placement for a few minutes. What happens at that point is that it seems to allow for a bridge (for want of a better term) to be made - allowing the energy to begin flowing again. They can also do this for themselves - with hands on, or even just by placing a thought or intention on the area of concern and visualizing the energy flowing freely, much like a creek, stream or river. It's as if the body needs to be reprogrammed, after a traumatic injury, to allow the process of healing to take place.

Thank you for this info.

 

[Roger Dodger]

Crush trauma/nerve damage - warning, a little graphic

Nutriwest has a supplement called Total-Inflam that your clinic may be interested in. Also, Traumeel (from Heel) can be good for inflammation... it is a cream. And, I believe Arnica Gel can sometimes be used, depending on the nature of the injuries and such.

 

[jiggles]

Crush trauma/nerve damage - warning, a little graphic

I work with a gal whose horse fell on her, crushing both her feet. She did require surgery on both feet... and they considered amputating the most badly crushed foot, but miraculously were able to avoid it. That was 2 years ago.

I have used MFR on her, spent a good portion of the session on her feet and lower leg... but not only did she feel better (all over), her balance was greatly improved. (She could stand on one foot much longer.)

My client was a personal trainer & still does quite a bit of physical activity. And yes, she still rides horses. LOL

Thought I would just let you know... there can be a good outcome.

 

[DeweyWatermelon]

Crush trauma/nerve damage - warning, a little graphic

The Traumeel Pueppi mentioned is great stuff - and it's available as more than just a cream. There's a homeopathic version that can be taken orally, as well as an injectable version that can be used instead of the usual steroid type injections people often get! Also other herbal antiflammatories such as Curamin, or Zyflammend are great too. There is another oral one I can also recommend by Dr. William Wong - which can be found on line at this website: http://www.totalityofbeing.com/FramelessPages/DrWongsRecommendations.htm

 

[mizfurrocious]

Crush trauma/nerve damage - warning, a little graphic

This thread has drifted into the recommendation of supplements and other non-massage "cures" that are outside the scope of practice of massage therapy. While it may be appropriate for discussion between peers, we must be extremely cautious about recommending any of these products to our clients. What is helpful to one person may be harmful to another, and we are unqualified to make those determinations.

I refer clients that may benefit from some form of supplementation to others who are qualified to provide professional guidance. I refer questions about acupuncture to acupuncturists and questions about herbs to herbalists. If relevant, I may share some of my own experiences with a client, but I limit my specific recommendations to "You may want to learn more about ... and see if you think it may be helpful. If you like, I can recommend someone qualified to answer questions you might have."

 

[Lulu Panda]

Crush trauma/nerve damage - warning, a little graphic

I do not believe this thread "drifted" anywhere---

Frankly, this is a peer-related section of the forums, so this tone of chastisement is really uncalled for, as is the statement "...and we are unqualified to make those determinations.". As a global forum, how MT's practice with such items, depends on city/state & even country. Your statment is also somewhat presumptious in suggesting that all forum members are only educated in massage therapy.

As the name of the forum (Bodywork Online) suggests, "bodywork" encompasses a multitude of facets and different practitioners may work with such as their repertoire allows.

If you or the admin of MassagePlanetL feels the members of this forum and outside readers may benefit better with a disclaimer, perhaps stating something along the line of... "MassagePlanetL holds to the opinion that individuals should only utilize supplements and herbs as is within their scope of practice." would be better received.