The Manual Guide to Massage Therapy
by Joanne McNamara RMT


Available at:
Trafford Publishing
Amazon.com


Originally titled “Clinic Handbook,” I put together this piece of work as my reference guide when working in the student clinic while attending school at the West Coast College of Massage Therapy in Victoria, British Columbia.  Though it is no longer titled as such, in many ways, it is still nothing more than a “reference guide.”

This 540-page book, with 33 pages of color pictures of both muscles and joints, extensively covers the muscular,

ligamentous, nervous, and blood vessel anatomy that relate directly to the massage therapist.

Muscle testing, applicable special tests, dermatomes, myotomes, cranial nerve testing, basic massage therapytechniques and joint mobilizations are featured. In addition you will find a brief description of over 70 conditions including the definition, etiology, signs and symptoms, contraindications, baseline, treatment techniques and goals, hydrotherapy techniques, and homecare. A special section on hormones and their respective functions is also included.

Massage therapy students in British Columbia undergo a 3,000-hour plus program and then sit two days of board exams in order to receive their designation – registered massage therapist (RMT) – as set by the College of Massage Therapists of British Columbia (CMTBC), the regulatory body, governed by the Health Professionals Act of British Columbia. The academic side of the course is exhaustive, comprising everything from basic anatomy to the how the body works on a microscopic, biochemistry level. This knowledge is what differentiates the BC massage therapy program from most other massage therapy courses.

This guide is written with the student and professional in mind. It is an integral source of information for the student. For the professional it is a tool to help jog the memory once examinations are no longer a part of daily life.

Back to this book; I sat down and started to put together the practical part of my education, so that I could see it all together and I could study for boards easier.  Though there is overlap between the practical and academic part of the course, this text in no way comes close to covering the academic portion of the education.  Therefore, the book is not to be used to diagnose, but is a guide so that when a client walks into your office, you can quickly look something up if you need to, and then carry on with the treatment.

To purchase the text directly from the author, Joanne McNamara, RMT, please contact her at (250) 245-0808 or via email at jemrmt@shaw.ca.  Cost is $110.00 plus shipping and handling.

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Massage Techniques
Myofascial Release
Myofascial Trigger Point Syndrome
Attachment Release
Muscle Energy Techniques
Contraindications of Massage Therapy
Uses, Indications, & Effects of Massage Therapy
Conditions
Special Tests
Cranial Nerve Testing
Dermatomes and Myotomes (Table)
Dermatomes and Myotomes with Reflexes
Special Features of the Skull
Special Features of the Cervical Region
Special Features of the Thorax
Special Features of the Upper Limb
Special Features of the Lower Limb
Innervation and Blood Supply
Cranial Nerves
Innervation of the Head, Face, Neck, & Trunk
Blood Supply of the Head, Face, Neck, & Trunk
Innervation of the Upper Limb
Blood Supply of the Upper Limb
Innervation of the Pelvis and Lower Limb
Blood Supply of the Pelvis and Lower Limb
Muscles
Muscle Testing
Joints and Ligaments
Joint Mobilizations
Hormones
Abbreviation List
Bibliography

Sprains

Sprain:  a traumatic injury in which one or more ligaments are stretched, twisted, or avulsed by temporary dislocation.  A wrenching violence of the joint that results in edema, bleeding, and possible formation of a hematoma and contusion; graded as mild, moderate, or severe.
Hemarthrosis:  due to ligament tear or osteochondral fracture; swelling is quick (20 minutes – 1 hour), skin becomes very taut, blood in synovial cavity, and has a doughy feel, though is hard to touch and warm
Synovium swelling:  increase of synovial fluid in joint cavity that occurs within 8 – 24 hours; has a boggy feel
Purulent Swelling:  joint surface is hot to touch, often red.  Client has general signs of infection


Contributing Factors:

• Congenital ligament laxity
• Previous history of sprains
• Altered biomechanics that stress ligament and joint
• Connective tissue pathologies


Etiology:

Direct Injury:  direct stress to joint with sudden twist or wrench beyond normal ROM (falling onto the joint)
Indirect injury:  secondary to improper placement of limb (forceful planning of foot; twisting ankle)
Most Common Areas to Sprain:  ankle, knee, wrist, shoulder


Signs & Symptoms:

Mild:
• Minor stretch of ligament
• Pain mild and local to site on activity
• Minimal edema, heat, and bruising
• Joint is stable
• Client may continue activity

Moderate:
• Tearing of some or many fibres
• Snapping noise is heard and joint gives way
• Pain is moderate at rest and with activities
• Moderate local edema
• Joint instability slight, if present
• Client has difficulty continuing activity

Severe:

• Complete rupture or avulsion fracture of ligament
• Snapping noise
• Pain may be intense or mild at rest
• Marked local edema, heat, and bruising
• Hematoma, joint effusion, hemarthrosis, strains, and contusion may occur
• Signs & Symptoms (Continued)
• Acute:  4 – 5 days
• Edema, heat, and bruising may be present
• Pain during activity and at rest
• Reduced ROM, muscle spasm

Subacute:  7 – 14 days

• Reduction in edema
• Bruising is yellow, green, and brown
• Muscle spasms, reduced ROM
• Loss of proprioception
• Adhesions maturing

Chronic:  immobilization 6 – 8 weeks, total healing = 6 months

• Pain localized only if ligament stressed
• Bruising is gone
• Adhesions are mature
• Hypertonicity, TrPs in compensatory muscles
• Full ROM is restricted
• Pocket edema may remain local to ligament
• Tissue is cool due to ischemia
• Loss of proprioception, joint unstable (severe)
• Muscle weakness and atrophy present due to immobilization

Contradications:

• Testing other than AFROM to prevent further damage
• Avoid removing protective muscle splinting of acute sprains
• Distal circulation techniques in acute or early subacute stages to avoid congestion
• XFF if PT is on anti-inflammatories or blood thinners

Baseline:

• Posture assessment
• Gait analysis
• Girth measurements
• Color of skin

Acute:

• AFROM painful motion last

Subacute:

• AFROM, PRROM, painful motion last
• ARROM of muscles at joint are strong and painless, injury is strictly ligamentous

Chronic:

• AFROM, PRROM painful motion last
• ARROM checking for disuse atrophy

Special Tests:

Acute:

• Patellar tap test (“Ballottable patella”)
• Minor effusion test

Subacute:

• Ligament laxity
• Anterior or posterior drawer
• Squish test

Chronic:

• Ligament laxity test

Treatment Goals

Acute:

• Reduce inflammation, edema
• Reduce pain, decrease SNS firing
• Treat compensatory structures
• Maintain local circulation proximal to injury
• Reduce muscle spasms
• Maintain ROM
• Do no disturb hematoma

Subacute:

• Reduce inflammation, edema
• Decrease pain, decrease SNS firing
• Prevent adhesion formation
• Maintain local circulation proximal to injury
• Reduce spasm, TrPs
• Maintain ROM
• Do not disturb hematoma

Chronic:

• Reduce any chronic edema
• Reduce SNS firing
• Reduce hypertonicity, TrPs
• Reduce adhesions, treat scar
• Restore ROM
• Increase local circulation

Treatment Techniques:

• Acute Techniques:
• Directed breathing
• RICE
• Proximal MLD, unidirectional effleurage
• Gentle kneading, effleurage, petrissage proximal to lesion
• PRROM and joint mobilizations to proximal joints
• Treat compensatory structures with slow petrissage, kneading, C-scooping

Subacute Techniques:

• Directed breathing
• More aggressive proximal drainage techniques:  effleurage, kneading, stroking, petrissage
• MLD at periphery of edematous area
• Light to moderate long kneading, GTO release, TrPs, muscle stripping to guarding muscle, compensatory structures
• On site vibrations, gentle stroking, kneading to pain tolerance
• Xff at site, joint play followed by ice (mild to moderate)
• Distal drainage technique if congestion no longer apparent
• Proximal and distal joint play if hypo-mobile (late subacute)
• PRROM in mid-range in late subacute for mild and moderate sprains

Chronic Techniques:

• Deep, moist heat (hot wax) to soften adhesions
• Moderate to deep wringing, kneading, stroking of proximal and compensatory structures
• Skin rolling, XFF, muscle stripping, joint play followed by ice for mild and moderate sprains
• Fascial release, MLD, and contrast hydrotherapy to reduce chronic edema
• Contract-relax
• Fascial techniques
• PRROM of proximal and distal joints if immobilized
• Distal effleurage and petrissage to increase venous return

Self-Care:

• Ice; contrast effusions in acute and subacute stages
• Self-massage, skin rolling, muscle stripping, gentle frictions in subacute and chronic stages

Acute:

• Maintain ROM with AFROM of proximal and distal joints
• Isometric for mild or moderate sprains with no strains, or with mild strain

Subacute:

• Maintain strength by AFROM of affected and distal joints
• Isometric exercises may be introduced for severe sprain, proprioception • exercises

Chronic:

• Increase strength with isotonic exercises, balance board, graduated stretching
• Tape or brace for activity

Treatment Frequency:

• Shorter, more frequent treatments will address inflammation process in acute stage, treatment may progress to once (1) a week for chronic stages
• Outcome variable, depending on severity of injury, treatment, PT’s general health, age, and compliance

Special Tests for Thoracic Outlet Syndrome

Adson’s Test:

• Tests for anterior scalene compression
• Is the most common test for TOS
• Therapist locates the PT’s radial pulse
• PT rotates their head to the side being tested
• PT extends head
• Therapist laterally rotates and extends PT’s shoulder
• PT takes a deep breathe and holds it
• A + Test:  The radial pulse diminishes or disappears

Costoclavicular Test (Military Brace Test):

• Tests for compression of the neurovascular bundle between
the clavicle and the 1st rib by subclavius
• PT is sitting
• Therapist stands behind PT and monitors the radial pulse
• Passively push the shoulder down and back
• A + Test:  Diminished pulse or duplication of symptoms

Halstead Test:

• Tests for a long C7 TVP or a cervical rib
• • PT is sitting
• Palpate radial pulse
• PT’s neck is hyperextended and rotated to the opposite side
• Apply a downward traction on the test extremity
• A + Test:  An absence or a disappearance of the pulse

Roos Test (EAST):

• Tests for TOS
• PT is in standing position
• Abducts arm to 90°
• Laterally rotate shoulders
• Flex elbows 90° so that the elbow is slightly behind the frontal plane
• PT opens and closes hand slowly for three (3) minutes
• A + Test:  If any of the following are felt (on the affected side):
• If unable to keep arms in position for three (3) minutes
• If there is ischemic pain
• If there is profound weakness of the arms
• If there is numbness and tingling of the hands

Scalene Cramp Test:

• Tests the scalenes for TrPs or neurological problems
• PT is sitting
• PT rotates head to affected side and pulls chin down into the hollow above clavicle by flexing the cervical spine
• A + Test:  Pain

Wright’s Hyperabduction Test:

• Tests for pectoralis minor compression
• Test first in the sitting position and then in the supine position
• Therapist palpates for the radial pulse
• Therapist hyperabducts arm over PT’s head with shoulder laterally rotated
• If the PT takes a breath or rotates and extend the head and neck, the PT may feel additional effects
• A + Test:  Palpate the radial pulse for differences

Scapular Muscles that Move the Humerus

Deltoid:

• Triangularly shaped
• Origin – Anterior Fibres:  lateral 1/3 of the clavicle
• Origin – Lateral Fibres:  acromion
• Origin – Posterior Fibres:  spine of the scapula
• Insertion:  deltoid tuberosity on the humerus
• Action – Anterior Fibres: flexes arm at shoulder joint
• Action – Anterior Fibres: medially rotates arm at shoulder joint
• Action – Lateral Fibres:  abducts arm at shoulder joint
• Action – Posterior Fibres:  extends arm at shoulder joint
• Action – Posterior Fibres:  laterally rotates arm at shoulder joint
• Innervation:  Axillary Nerve

Teres Major:

• Long and round
• Origin:  inferior angle of the scapula
• Insertion:  intertubercular sulcus – medial lip – of the humerus
• Action:  extends arm at shoulder joint
• Action:  assists in adduction and medial rotation of arm at shoulder joint
• Innervation:  Axillary Nerve

Coracobrachialis:

• Coraco: = coracoid process
• Origin:  coracoid process of the scapula (with short head of biceps brachii)
• Insertion:  middle 1/3 of medial surface of the humerus
• Action:  flexes arm at shoulder joint
• Action:  adducts arm at shoulder joint
• Innervation:  Musculocutaneous Nerve