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For several years I have had a practice specializing in individualized muscular skeletal therapy, an innovative approach to bodywork which has helped many of my clients avoid surgery. But, I had not had the opportunity to work on broken bones until about a year ago, when I began to treat injured hands. I learned, as a result of this experience, that a structural therapist, like me, can successfully treat broken hands by relying on tactile sensitivity, knowledge of anatomy and creative thinking "outside the box."

Currently, most bodyworkers, whom I will refer to as therapists in this article, avoid treating broken bones of any kind. Some work with physical therapists rehabilitating clients only after they have been under the care of physicians and are recovering from conventional treatment of fractured bones. However, there have been some new developments regarding broken hand treatments which enable therapists to have a role earlier in the healing process, immediately after their clients have been seen by physicians. My experience with these techniques, which I will explain in this piece, is that effective muscular skeletal therapy can make it possible for broken bones to heal quicker without surgery or additional treatment by physicians.

CONVENTIONAL TREATMENT OF FRACTURES

The traditional immediate care for a broken hand depends upon the severity of the injury. A simple break may be treated with a splint, ice and rest. A more complicated break may require surgery to realign the broken bone by implanting wires, plates, rods or screws into the broken bone to maintain proper alignment during healing.

Fractures usually heal in about four to six weeks, but some can take several months depending on the extent of the injury and how well a patient follows rehab instructions. Casts or braces are often removed before complete healing to prevent joint stiffness. Pain usually decreases before the fracture is solid enough to handle a complete return to sports. So working with a therapist on a rehab protocol is important to avoid further injury.

Once the bone is healed and strong, it's safe to begin muscle building. During the disuse, the muscles will have atrophied and be extremely weak. Tendons and ligaments may also be stiff from a lack of use. Rehabilitation involves flexibility, balance and strengthening exercises and a gradual increase of activity. Physical therapy is the preferred method of safely getting back into sports.

The Individualized Approach:

The new method for rehabilitating broken bones that have been treated with individualized bodywork, is a type of massage therapy that involves treating both the site of the injury and other parts of the body that have been overused because they have been substituting for the broken bones and compensating for the loss of function in the area where bones were broken.

There is a tendency for the tissues to be dysfunctional. They must be restored to normal function by manual treatment of ligaments, tendons, joints, connective tissues and muscles. In addition, trigger point therapy must be used if there are trigger points from trauma that originally caused the injury or from the patterns that are created by compensation for the injury.

The new individualized bodywork therapeutic method for similar or even the same types of breaks varies with each individual based on the client's unique needs and not solely on the similarities of all broken hands. Every injury and pain condition with respect to broken hands is different although the differences between two people with the same broken bone can be very slight. The therapist must determine the differences through palpation and vision to be most effective in the therapy. For example, if a client has a break of the fourth metacarpal bone and if tendons and ligaments are preventing the bone from healing, then treatment is done on tendons and ligaments. But if another person has the same type of break and myofascial tissue is pulling on the fracture, the therapist may need to realign the tissue with utilizing precise manipulation.

Bodywork is not only based on science. It is an art form. Anatomical knowledge is essential for advanced bodywork, like the individualized structural therapy I have developed. But creativity is just as important. To treat serious injuries so they heal quickly a therapist must be detailed, precise and have extremely fine tuned touch. The therapist who has sensitive touch can develop the ability to discover the depth of a broken hand's dysfunction and thereby help his or her client heal well rapidly and without the pain, expense and functional disruption that is connected with surgery. Each client's individual situation must be assessed keeping in mind that each person is unique and the massage therapist should not think, "I have worked on other people with the same problem so I know what to do. It worked before so it will work now"

To lump all clients with broken bones in the same category and treat them the same is a recipe for disaster given the sophistication and complexity of the human body. I will illustrate this by describing two cases of broken hands that were successfully corrected.

ILLUSTRATIVE CASE HISTORIES

Client A came to see me immediately after his injury occurred. Client B I saw three months after he was injured and a hard cast had been removed. What they had in common is that their doctors thought they would need to have surgery. But when both patients asked their doctors to allow them to try something different, i.e. individualized structural therapy, their doctors agreed. Of course, I did not touch either client without first conferring with their physicians. Even though each client had a different doctor, each physician was skeptical about the effectiveness of any kind of massage therapy or bodywork and both said their clients would be wasting their time and money being treated by me. But, neither one thought that what I was going to do, after I described it in detail, would harm their patients. Both doctors reluctantly agreed to give this unconventional method a chance.

CLIENT A: A HAND TREATED AT TIME OF BREAKAGE

Client A is a very athletic former college football player and martial artist .He broke his fourth metacarpal bone while defending himself from a real attack by another person who was attempting to rob him. I started therapy of his hand within 48 hours of the time the injury occurred. His hand was severely inflamed. I first did massage with ice directly on skin where it was inflamed. Then, through some palpation, I found myofascial dysfunction of certain muscles of the hand. So I did myofascial manipulation in the exact direction of correction to the hand muscles, which are Adductor pollicis, adductor pollicis brevis, and flexor pollicis brevis. Then, I did very precise movement of the connective tissues at the right depth of dysfunction and the direction of correction to the metacarpal bones. I used the manual technique of hooking the bones on the periosteum and did not touch the exact area where the break occurred. But, I did work on the surrounding areas. The bones there felt like an adhesive pad, very sticky from connective tissue dysfunction.

The results of these treatments were that, within 2 weeks, Client A could close his hand without any pain and after each week of treatment Client A's hand movement improved significantly. After 2 months of working on him once every week, I gave Client A an exercising puddie so that he could start really strengthening his hand. After 3 months his doctor told him that he did not need surgery. After 5 months he could do pushups without any pain or discomfort on his knuckles. This is what can happen with the correct immediate manipulative treatment of a broken hand. Client A's hand has now recovered completely from the injury and he is not limited in any way.

CLIENT B: EFFECTIVE, QUICK REHABILIATION

Client B's experience is a good example of how this new individualized structural therapy can be applied to broken hands to make rehabilitation rapid and effective. He is an amateur boxer who broke the first metacarpal bone of his hand as the result of a fall. He was in a hard cast for about 3 months before I started to treat him. When the doctor removed his cast he could hardly move his hand and his thumb was completely frozen.

This client had severe compensation in his forearm .He had many trigger points in his forearm muscles referring to the wrist and hand from the muscles extensor carpi ulnaris ,extensor carpi radialis, brevis,abductor, pollicis longis and extensor pollicis brevis . The opponens pollicis muscle had severe myofascial dysfunction; the carpometacarpal joint had extreme dysfunction and lack of movement. I did trigger point therapy on the forearm muscles and worked on the opponens pollicis muscle which had the fascia pulling in different directions. This meant that the direction of correction was very complicated.

I manipulated the thumb through the joint and around the whole thumb which needed fascial unwinding. Each session with Client B ended with his thumb movement getting better until, after 6 weeks, it became normal.

When I was working on his thumb Client B could feel the pull of the fascia all the way through the whole forearm. The base of the first metacarpal bone needed to be treated on the periosteum of the bone at the exact direction of correction and depth of dysfunction to bring the bone to normal function.

I saw Client B two sessions every week for six weeks. Pain and range of motion improved every session. After two weeks I gave him an exercise puddie so that he could use it to regain strength in his forearm hand and wrist. As a result, Client B achieved full range of motion and was free of all pain in 6 weeks. After 3 � months of using the exercise puddie he regained all the strength he had lost.

In this article I have demonstrated how a new approach to bodywork called Individualized Structural Therapy can be utilized to fix broken hands successfully. The key factor is to determine, through tactile sensitivity, the depth of dysfunction and to manipulate joints, periosteum of bone, muscles, tendons, ligaments, trigger points or connective tissue, as deeply as it is necessary to probe, in order to restore clients' hands to normality.

Individualized Structural Therapy, as we have noted above, is precise. No two people with broken hands will be treated exactly the same. There could be as little as two centimeters difference but the precision and detail of treatment utilizing eclectic techniques and sensitivity of touch result in healing a broken hand and thus, in successful restoration of the hand's movement and function.