piriformis attach can be treated by the therapist with either deep effleurage or cross-fiber friction. Straight leg test (Testing for the cause of lower back pain.) The client is supine on the table. Beginning with the client’s leg adducted and medially rotated, the therapist grasps the client’s heel and keeping the knee in extension, slowly raises the leg until the client feels pain or discomfort. The leg is slowly lowered until there is no pain felt. (Note that the foot may be placed into dorsiflexion in order to test for a sciatic nerve impingement.) Tension in the hamstrings will be indicated by pain in the posterior thigh and/ or the posterior knee. A lumbar or sacral dysfunction will be indicated if the client is in pain after 70 degrees of flexion at the hip. A herniated disc will be indicated if the client experiences
pain down the leg not being raised. A sciatic nerve impingement will be indicated by pain down the client’s leg when the leg is lowered and the foot is dorsiflexed. If a herniated disc is the source of dysfunction, the therapist will not attempt to correct the hernia and not move the client through any ROM at their hips. Tension in the hamstrings can be treated with any of the massage techniques listed below. There are more assessments for treatment planning for the quadriceps and hamstring groups and for the leg and foot muscles. However, the assessments detailed in this section should give a therapist a place from which to start conceiving their own tests. For therapists wishing for more information on these types of assessments, an Orthopedic Massage course may be in order.
BEGINNING THE MASSAGE: PALPATION AS A TOOL
By definition, palpation means to touch with a purpose and intent. This tool can be used before the massage begins during the interview in such instances the client describes an area of pain or other dysfunction. The therapist can palpate the area the client indicates with varying depths of pressure to get a sense for what protocols may be necessary to treat the condition. If the therapist feels hypertension, trigger points (irritable knots), spasms, swollen lymph nodes or edema, an appropriate plan can be developed or necessary tools gathered before actually performing the massage. Palpation as a tool is an ongoing process, though, and must be used during the massage as well to assess changes to the client’s tissues. There are certain aspects of the client’s body the therapist can palpate before and during the session in order to understand the client’s condition. Foremost among these aspects are anomalies: Does the client’s body display a condition that is outside what is normal for the public at large? If so, the client can be asked if they are aware of the anomaly and what may have caused it. Some anomalies, such as certain small lesions on the skin, may indicate the presence of a skin parasite and thus rule out massage for that day. A therapist is also looking for restrictions in the client’s superficial fascia (underlying connective tissue). Does the client’s skin move easily over their superficial muscles? If not, the therapist should consider using a non-lubricated technique such as myofascial release to loosen superficial restrictions before applying a lubricant and working on deeper muscles. Common massage techniques used during treatment The following list of massage techniques that fall within a therapist’s scope of practice may be used in treating clients. An important point to remember is that not all techniques work equally well on all clients and in some cases, depending upon information given by a client, may not be used. Also, depending upon client preferences, varying degrees of pressure may be used with certain strokes and this too can influence how effective massage is in treating a client’s condition. Effleurageis This is perhaps the most common massage technique and used in the application of lubricants to a client body. Its strokes are long, broad, calming, and gliding, and are often used to cover large areas of the body with a single stroke. Usually, effleurage is done with light to medium pressure since it is primarily considered a preparatory stroke. The purpose of these strokes is to provide a general sense of relaxation and prepare the muscles for any deeper massage that may take place. On occasion, a deep effleurage may be attempted with forearms in an attempt to use a variety of strokes and to ease wear on the therapist’s hands and thumbs. This technique is effective for relieving tension associated with stress or anxiety, but is not usually effective in reducing hypertension associated with injuries (e.g. strains or sprains) unless the stroke is deep. Petrissage This is effective for relieving chronic stress and hypertension. It is characterized by a kneading or squeezing motion in which
The next question is to determine the temperature of the client’s skin. Skin that feels cool to the touch may mean the client is suffering from ischemia, that is, a lack of blood flow to their skin or muscles. Friction, hot stones or hot compresses will usually correct ischemia. Warm or hot skin may indicate the client has local inflammation or even a fever is the warmth is even throughout the body to the therapist’s touch. While inflammation can be reduced with ice or a cold compress, the presence of a fever is an absolute contraindication. Along with inflammation, is edema (swelling) present and how widespread is it? Are the areas mushy or spongy to the touch? For clients who indicate a heart or kidney problem, a massage might be contraindicated depending upon their medication, and they may need a physician’s approval before proceeding with a massage. The therapist may also attempt to sense any twitching or trembling of the client’s muscles in order to locate trigger points, with trigger point therapy having its own unique protocol. Finally, how is a client reacting to being touched? Are certain depths of pressure painful or uncomfortable to the client? Is the pain or discomfort restricted to one area? The therapist may have to adjust their touch accordingly or consider the use of specific tools. Collectively, these aspects will influence how the massage is conducted by indicating what techniques can and cannot be used. portions of either skin or muscle are handled in the entire hand between the fingers and thumbs. This technique can stimulate blood flow and loosen muscles, as well as assist the lymphatic system to move lymph through the body to be filtered by the lymph nodes, spleen, and liver. Moderate to firm petrissage can be performed on large muscle group such as the biceps or quadriceps as they are lifted away from the body, squeezed and released in a slow, circular, rhythmic fashion. Although this stroke targets the belly or center of a muscle or muscle group, petrissage can also be used upon small areas using the first two fingers and the thumbs. Friction This can loosen tension at the joints by realigning muscle fibers near their attachment sites; basically, by massaging the muscle where the muscle’s tendon meets its boney attachment in a direction perpendicular to the muscle/tendon fibers. It is effective in breaking down restrictions in superficial fascia and scar tissue are among its other uses. This technique is usually done with medium to firm pressure with the thumbs or fingertips and may be uncomfortable for the client as well as produce inflammation locally, so the therapist should inform the client ahead of time of the benefits and considerations of this stroke. Tapotement This is done by rhythmically striking the muscles with light to moderate force with a medium to quick pace. It is used to tone up hypotensive muscles as well as stimulate the nervous
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Book Code: MLA1224
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