Condition-Specific Massage Therapy
LWW: Instructor Resources from Bucci, Celia. Condition-Specific Massage Therapy. © Lippincott Williams & Wilkins/Wolters Kluwer Health
Chapter 1 – The Basic Tools for Specific Treatment

What is condition-specific massage?
the application of massage techniques to treat the common contributing factors of a specific condition - while the techniques we use to treat pain may differ, many of the treatment goals remain consistent
In some cases, clients with the conditions described in this book may have issues or complications that require advanced skills and training to treat them adequately. If you are unsure of whether your skills are adequate to properly treat a client with a complicated condition, discuss it with a mentor or therapist with advanced training

Basics of biomechanics
Biomechanics is the study of how mechanical models apply to living organisms. the relationship between the bones and joints and the internal and external forces that act upon them to either make us move or stabilize static postures
muscle tension is the mediator in the push and pull between anatomical structures and the forces that act upon them
isotonic contraction - muscle tension is greater than the resistance against it, the length of the muscles responsible for the given action change to produce movement
concentric contraction - fibers shorten to produce the force needed for action
eccentric contraction - muscle lengthens isometric contraction - resistance is greater than muscle tension, the length of the muscle does not change and no movement occurs
“all or nothing” principle - when muscle fibers are recruited to perform an action, each myofibril contracts either completely or not at all
agonists - muscles that contract concentrically to produce movement prime mover - main muscle responsible for a given movement and is usually the biggest or strongest of the muscles responsible for that particular action synergists are muscles that assist the prime mover when the force needed requires the concentric contraction of several muscles
antagonists are muscles that oppose agonists to ensure that movement is fluid - antagonists lengthen against the shortening of the agonists to control the speed and rate of contraction

Range of motion
all of the possibilities of movement of a joint active ROM - the client moves the joint through its range by consciously contracting muscles passive ROM (P ROM) describes action at a joint, which is produced by a force other than muscle contraction across that joint resisted ROM (R ROM) is an active contraction by the client that is resisted by an external force

Health history
OLDRFICARA – onset, location, duration, radiation, frequency, intensity, character, aggravating factors, relieving factors, associated factors

Signs and symptoms (Table 1-1)
signs are objective and measurable by the therapist symptoms are subjective and are measured by the client use a pain scale when assessing the client's symptoms client’s description of pain can give you clues about the cause

Range of motion assessment (Table 1-2)
test active ROM of the joint first active ROM gives you information about both contractile and noncontractile tissues in and surrounding the joint passive ROM may reveal information about joint dysfunction that is unrelated to muscle contraction end feel is the term for the sensation the therapist feels when applying overpressure resisted ROM can give you information about the client's strength and the health of the nerves that send impulses to the muscles that move the joint being tested

Palpation (Table 1-3)
take your time with palpation - cover only 1 inch of tissue in 5-10 seconds focus intently when you palpate to avoid missing subtle details slow, deliberate palpation in an area solid with adhesions and hypertonicity may also release superficial tissues and reveal deeper, more specific causes of dysfunction avoid heavy pressure that may change the texture of the surrounding tissues, transfer too much information to the receptors in your fingers, and obscure your results Principles of massage general-specific-general - apply techniques generally both before and after applying them specifically superficial-deep-superficial - apply techniques to superficial tissues both before and after applying them to deeper tissues proximal-distal-proximal - apply techniques closest to the trunk before applying them to the extremities, finishing with strokes back toward the trunk peripheral-central-peripheral - applying techniques around the periphery of an injury before and after working directly on it

Physiological effects of basic strokes (Table 1-4)
physiological effects that may vary depending on the depth and speed of their application Arndt-Shultz law explains that weaker stimuli activate physiological effects while stronger stimuli inhibit them the most effective treatment includes a combination of strokes chosen and applied in a sequence specifically intended to produce a desired effect massage strokes may also be contraindicated by your treatment goals or may not be appropriate for clients with certain local or systemic conditions three basic effects of massage strokes are mechanical, reflexive, and chemical mechanical effect changes the shape or tone of the tissue and often results from force reflexive effect occurs when the stroke applied accelerates or decelerates a response, often in the nervous system, and is generally intended to restore homeostasis chemical effect occurs when a stroke encourages the release or absorption of chemicals in the body

Hydrotherapy (Table 1-5)
the temperature of the hydrotherapy source must be higher or lower than body temperature to have an effect hydrotherapy must be adjusted to the client’s tolerance the source of hydrotherapy should also always be covered by a clean wrap be sure that the weight of your hot or cold source is not so heavy that it would compress injured structures, nerves, or vessels if the water used in a bath has a higher concentration of salt than the body, water exits from the body through the skin into the salted water - this effect is best used therapeutically to reduce inflammation when the water used in hydrotherapy contains no salt, water from the bath will pass through the skin into the body - this is best used when tissues are dehydrated or to dilute a high concentration of metabolites contrast hydrotherapy involves alternating hot and cold applications

Mobilization
ROM techniques can reduce adhesions, restore mobility, increase circulation of blood and lymph, and reset neuromuscular function and proprioception limit movement to the client’s tolerance and use repetition only as long as the action remains comfortable when instructing the client in self-care, it is essential to demonstrate the activity you are recommending

Post isometric relaxation
proprioceptive neuromuscular facilitation and muscle energy technique are therapeutic methods that alternate periods of contraction and relaxation with the goal of resetting the nervous system so that a shortened muscle can lengthen more fully, the joint can move more freely, and proprioceptors can then return to normal function for a few seconds following a muscle contraction, nerve impulses are repressed, which allows the muscle to be passively lengthened further. This contraction should be initiated with the target muscle in a comfortably lengthened position

Client self-care
stretching, strengthening, and becoming more aware of posture and activity are some of the suggestions that may improve the treatment outcome when educating clients about self-care, you must consider their whole situation and make suggestions appropriate for their level of strength, general health, and stage of healing demonstrate all suggested activities to ensure that the client understands them clearly, reducing the possibility of injury a stretch is a procedure in which the distance between the bony attachment sites of a muscle is increased strengthening is achieved by actively contracting the targeted muscles that have been lengthened or weakened - an active contraction occurs when one deliberately brings the bony attachment sites of a muscle closer together

Breathing
Shallow breathing contributes to anxiety, emotional distress, and pain. Slow, diaphragmatic breathing calms the sympathetic nervous system and delivers more oxygen through the circulatory system. When used in treatment or during self-care, deep breathing can enhance muscle relaxation, reduce the client’s anxiety, and help your client focus on the moment.

Treatment Goals
reduce adhesions - kneading, cross-fiber friction, heat, stretching, and mobilizations and specific myofascial release strokes may reduce adhesions increase circulation - gliding, kneading, heat, mobilizations, stretching and percussion may increase circulation - when repeated, compression and release may cause a flushing of the circulatory system reduce tension - gliding, kneading, heat, mobilizations, stretching, post-isometric relaxation, and broad compressions help reduce tension and restore normal resting tone lengthen tissue - firm and deep gliding strokes along with pin and stretch techniques are ideal for manually lengthening tissues treat trigger points - deep gliding, cross-fiber strokes, compression, heat, and stretching help to deactivate trigger points passive stretch - achieved by increasing the distance between the attachment sites of the affected muscle while the client remains relaxed clear area - broad gliding strokes, both superficial and deep, are ideal for clearing locally and systemically; mobilizations may also help increase circulation and clear the local area strengthening weakened muscles – actively contracting the targeted muscles; best performed as self-care