In October of 1987, I took my first soft tissue/friction massage course given by Dr. Hammer. At this point in time I had been practicing motion palpation for a few years and was quite adept at analyzing joint play. The idea of being able to analyze a joint system more thoroughly and specifically diagnose the source of pain quite intrigued me. By the time I had finished my first weekend course, it was apparent to me that friction massage was going to be for me, now, what motion palpation was to me after my first year of school. I left the course very excited and raring to go the following day in my office.
I knew that the only way to make use of this course was to put it to work immediately. I copied all of Dr. Hammer's analysis charts and decided that I would use these charts in a slow and methodical manner until I became adept enough to analyze a problem without the use of the charts. I must admit, it seemed like a slow process, but on Tuesday, after taking the course, I got the husband of one of my most valued patients in with a chronic knee problem.
This patient was a steel worker who was used to climbing, jumping, and carrying heavy loads for most of his adult life. He had injured his knees approximately two years earlier and required arthroscopic surgery on both medial menisci for torn cartilages. The result of this operation was good, but the patient was left with residual pain and was unable to return to his normal job for approximately six months. Since the pain remained chronic for approximately one year, another arthroscopic surgery was done to explore the area inside both knee joints, and this showed no apparent cause for the continued pain. The patient's initial injuries involved repetitive internal torsion to both knees.
I took out my chart and performed a thorough analysis involving the passive and contractive structures of the knee. As I was doing this, the patient related to me that he was told that if his pain did not go away within the next two months, he would be given complete knee replacement to both knees and would most likely not be able to perform any kind of physical work for the rest of his life. I performed each test, checked off my findings and actually found the knees to be quite functional until I got to the passive testing. Upon passive testing of both knees, the patient had some mild pain on full flexion and severe pain upon passive lateral rotation of both knees. I was excited! I hurried out of the room to look at the chart and came up with the fact that the menisco-tibial ligaments must be involved. My heart began to palpitate. I could not believe that a patient with such a simple problem could be so incredibly misdiagnosed. Since I had adequate time and the patient had nothing to lose, I began doing transverse frictional massage to the right menisco-tibial ligament the first day. I did this for approximately ten minutes as I was taught in the class. The patient was then ultrasounded and I noticed a red mark in the area where I had worked. I sent him home to return the following day. The next day the patient returned with a relatively severe blister which was raw and bleeding. I thought to myself that I was never going to do transverse frictional massage again until the patient told me that he had not had that much relief from his knee pain for well over a year and that it was incredible that in one visit I could make his knee feel so good. Again, I thought -- how could a problem be so simple. For the second visit I did transverse frictional massage to the left menisco-tibial ligament, only this time I did it properly and did not bruise the skin. The patient returned approximately two days later and said both of his knees felt so much better that he couldn't wait until the next appointment. I treated each knee approximately six times for the prescribed ten minutes and the patient was completely relieved of all symptomatology. It just so happens that he had another appointment at the University of Connecticut Health Center the following week in order to re-analyze the knees. When he went back to his orthopedist at the University of Connecticut (UCONN) and was completely symptom free, his orthopedic surgeon called me on the phone in the middle of seeing patients. At that point in time I had only been in practice a short time, so when I got a call on the phone from an MD, my heart skipped a few beats, while I wondered if it was going to be a call telling me something had gone wrong with one of my patients. He was absolutely thrilled that I had found a way to fix his patient conservatively and proceeded to ask me about what I had done, where I had learned it, and how I had learned to analyze so thoroughly. Needless to say, the rest of my day was perfect. The orthopedic surgeon asked me to come and speak to a group of MDs at UCONN regarding transverse frictional massage and diagnosis of soft tissue injuries. The talk turned out to be very rewarding and opened up a communication line between myself and a prestigious medical college in Connecticut. It also made some professional inroads for chiropractic in Connecticut. I have now been doing transverse frictional massage regularly for approximately two years and have found it to be the best addition to my practice since motion palpation.
Needless to say, I think Dr. Hammer's soft tissue diagnosis course is absolutely essential to a well-rounded practice.
George G. Bruno, D.C.
Torrington, Connecticut
The name of the game is getting sick people well and Dr. Bruno demonstrates that the best practice building course is one that teaches you how to get sick people well. --- Warren Hammer, M.S., D.C., D.A.B.C.O.
