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Melbourne College of Professional Therapists "Excellence in Education" Deep Tissue Techniques (Massage 3)

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Melbourne College of Professional Therapists"Excellence in Education"

Deep Tissue Techniques (Massage 3)

Melbourne College of Professional Therapists"Excellence in Education"

Suite 5 – Ground Floor

(Right path way entrance, next door to Lifestyle Gym) Cnr: Ferntree Gully Rd & Jells Rd

Wheelers Hill (Vic) 3150

Postal: P.O Box 3171 Wheelers Hill (Vic) 3150

Facsimile: 9560 4523

9562-2280

These notes are © SDCA PTY LTD trading as Melbourne College of Professional Therapists - MCPT. All rights reserved. No part of these notes may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise without the express written permission of SDCA PTY LTD.

These notes are intended as a guide only, and do not take the place of attendance in scheduled classes.

Revised January 2004

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Table of contents Page

Assessment techniques 2 Subjective examination 3 Objective examination 4 General principles of assessment 5 Granter King pain scale 5 Assessment and Treatment overview 6 Postural assessment

Ideal 7 Kyphosis 8 Hyperlodosis 9 ‘Sway back’ 10

Hypolordosis 11 Clinical applications of deep massage 12 Important aspects of deep work 12 General pattern of deep massage 13 Common Trigger points 14 Relevant terminology 15 Suggested treatment strategies

Foot/Ankle joint/Calf 19 Lower Leg 21 Knee and Upper leg 23 Pelvic girdle 26 Thoracic 30 Neck 33 Shoulder 35 Arm 38

Baby massage 40 Where to now 43

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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ASSESSMENT TECHNIQUES WHY ASSESS? Assessment helps to determine what is to be treated, how it may be treated and gives a baseline to establishes the effectiveness of treatment. The aim of assessment is to find the problem. 1. Establish client/therapist rapport. 2. Ensure the aims of treatment and assessment are understood by

client. 3. Take notes for professionalism and evaluation.

1. Why do you think this is important? 2. Why do you think this is important? 3. Why do you think this is important?

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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SUBJECTIVE EXAMINATION

Name?

Address

Phone number?

Occupation?

Sport?

Level of competition?

What is your problem?

Where is the pain/stiffness/weakness?

How does it feel?

Do you notice any pins and needles/numbness?

What makes the pain worse?

Is the pain worse in the morning?

Are you generally healthy?

Have you had X-rays taken?

Have you been given any medication?

Current History

Previous Injury

Past treatment what has helped previously/to date?

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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OBJECTIVE EXAMINATION Observation

a. General - of the patient as a whole - posture, walking, standing etc. - gait

b. Local - skin, eg. Scars, folds, colour - muscle contour, size - bony prominences - bony alignment

Active Movement - of associated areas Passive Movement - pain/stiffness/reproduce symptoms Resisted Muscle tests Palpation

Feel the areas involved look for muscle tone, trigger points, swelling, and crepitus.

The therapist's role in the rehabilitation of the client may also involve psychological support, motivation and reassurance. Often an accurate prognosis estimating full return to previous level of activity will help the client to achieve optimum activity. Prevention of any re-occurrence of the injury or maintenance of the clients’ quality of life can be facilitated by post treatment exercises to be done as homework by the client.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Some General Principles for consideration in assessment and treatment 1. Properties of Fascia and Connective Tissue 2. Principles of Muscle Imbalance Granter King Treatment Scale Pain awareness scale

Depth – felt by therapist

Depth of tension

1

Grade I

Indicated in post-acute

treatment of inflammatory conditions

Just when base tissue tension is

felt

2

Grade II

Some resistance

3

Grade III

(Grades II and III are recommended effective

therapeutic depth)

Moderate resistance

4

(some level of pain)

Grade IV

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Assessment and Treatment overview Interview ROM Resisted Treat Re-test

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Postural Assessment Ideal alignment

This is the ‘ideal’ standing position. Please note that if you draw a straight line from the top of the head down to the floor, the line should pass just behind the ear, and finish up just in front of the ankle.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Kyphosis/Cervical Hyperlordosis

Short and strong: - Neck extensors and Hip flexors Elongated and weak: - Neck flexors, upper back erector spinae, and external oblique. Hamstrings may be weak. Corrective exercises - Stretch shoulder protractors - Strengthen thoracic spine and scapular stabilizers

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Hyperlordosis

Short and strong: - low back and hip flexors Elongated and weak: - anterior abdominal muscles. Hamstrings are elongated, and may be weak as well Pelvis is anteriorly tilted Corrective exercises:- - strengthen abdominals to maintain posteriorly tilted pelvis - stretch hip flexors and the lumbar spine

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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'Sway back'

Short and strong: - Hamstrings, upper fibres of internal obliques. Lower back muscles are short, but not strong. Elongated and weak: - one joint hip flexors, external obliques, upper back extensors and neck flexors. Posterior tilt of pelvis (whole pelvis is anteriorly displaced) Corrective exercises: - strengthen hip flexors and lower abdominal muscles

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Hypolordosis (flat back)

Short and strong: - Hamstrings, calves Elongated and weak: - one joint hip flexors Posterior tilt of pelvis Wasted buttocks Abdominals variable, sometimes weak, sometimes strong. Knees slightly flexed due to tight hamstrings. Corrective exercises: - - strengthen back extensors - stretch hamstrings - aim to increase the lumbar lordosis

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Clinical Application of Deep Massage Progressive deep work can be considered a valuable part of massage in relief of pain and restoration or maintenance of maximal muscle function. Generally with deep tissue work stiffness and soreness may occur for 24-48 hours after treatment. This should be replaced by a feeling of relief and may produce postural improvement, feeling ‘looser’, loss of pain, return of function and possible emotion release. Most muscle tissue should be able to tolerate deep pressure and experience discomfort due only to the pressure (with consideration for underlying structures). Deep work is aimed at achieving this. Depth in this kind of massage is guided by pain always. Sensation should never exceed a "totally uncomfortable" level. Remember the Granter/King pain scale. Deep pressure should be avoided near body prominences, underlying sharp structures, pathological sites inflammation and arteries and nerves. Three broad categories of techniques exist. 1. Cross Fibre frictions = this is a technique where you

work across the 'grain' of the muscle 2. Longitudinal = a technique where you work along the

muscle ‘grain’. An example of this is the rowing stroke

3. Direct pressure = press and release technique Combinations of these are possible to some extent. Important aspects of Deep Work: 1. It is always more effective if preceded by gradual

work and followed by appropriate stretching.

2. Watch for stress on your own body parts being used for deep tissue work.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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3. The tissue you are working on will tell you if pressure is good. There should be no recoil response of the part being worked on and strokes should still be smooth and flowing. In general if you feel a sensation of catching or blocking with strokes you are going too hard.

The general pattern for deep tissue massage is as follows-

1. Warm up work- using sequences/strokes taught previously. Warm up techniques are applied to the area under consideration to introduce touch and prepare the tissue for further work.

2. Longitudinal work- Muscle specific. The combination of

longitudinal and cross fibre techniques are assessing potential involvement and isolating problems.

3. Broad cross fibre techniques Press release and cross fibre

frictions are applied to the accessible origins and insertions of muscles, on the basis of involvement, to reduce tissue tightness.

4. Origin and insertion work techniques

5. "Point"' or "problem" orientated techniques can now be

applied to problem areas in priority order. Work should proceed from SUPERFICIAL to DEEP and often PROXIMAL to DISTAL. And Remember

- Never one hand when two hands can be used - No thumbs unless supported - Deep pressure only if controlled - If the person is holding tension in the area you wish to work then shake it. - Pick up tissue and work away from bone if possible - Intersperse soothing techniques with point work to prevent over stimulation.

General whole area work is undertaken before specifics to isolate ‘the problem’ and ensure correct time allocation in treatment.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Common Trigger points

Posterior Anterior

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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In the sections on regional treatment the following abbreviations will be used:

BCF- Broad Cross Fibre techniques BL- Broad Longitudinal techniques CFF- Cross Fibre Frictions PR- Press Release DIP- Digital Ischaemic Pressure

Terminology Relevant to Injury in these Areas: Abrasion wound caused by rubbing or scraping skin or

mucous membrane. Apophysitis outgrowth or swelling, bony outgrowth that

has never been entirely separated from the main bone eg tubercle.

Blister vesicle – bladder or sac containing liquid. Blood vesicle - containing blood. Water vesicle - containing water. Bone Strain (stress reaction) weakening of bone tissue due

to physical stress i.e. continuous lifting or running activities.

Bursa small fluid filled sac or sac-like cavity situated

where friction would otherwise occur. (padding)

Bursitis inflammation of the bursa. Chondral Fracture breaks in the continuity of cartilage tissue. Chondropathy disease (path) of the cartilage. Chondromalacia softening (malacia) of the cartilage. i.e.

therefore less cushioning in knee joint. Dislocation displacement of a bone from a joint.

The general pattern for Deep massage is as follows- Warm up work- using sequences/strokes taught earlier Longitudinal work- Muscle specific Broad cross fibre techniques Origin and insertion work “Point” or “problem” orientated techniques Work should proceed from SUPERFICIAL to DEEP and often PROXIMAL to DISTAL.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Entrapment damage to nerve caused by joint position or inflammation & swelling of structures (muscles, tendons) in close proximity to nerve pathways (lumbar spine, piriformis, sacroiliac joint) OR a combination of both due to continued destructive activity.

Fracture a break in the continuity of bone tissue. i.e.

complete, compound, greenstick etc. Increased Neural damage to nerve tissue caused by the Tension overuse of muscles & joints that put pressure

on or overstretch nerve tissue. Inflammation localised protective response elicited by injury

or destruction of tissues which destroys, dilutes or walls off both the injurious agent and the injured tissue.

Laceration wound produced by tearing of body tissue –

not a cut or incision. Ligament Sprain/ wrenching or twisting of a joint with Tear partial rupture of its ligaments and damage to

blood vessels, muscles, tendons & nerves.

Grade 1 micro tear – inflamed & swollen ligament & surrounding tissue. Pain on stressing ligament with no increased joint laxity. Grade 2 ligament tissue tearing resulting in weakened & softened ligament tissue-can be at periosteal attachment. Pain on stressing ligament with increased joint laxity, with definite end point. Grade 3 severed ligaments – Can be at periosteal attachment. Shows gross joint laxity without an end point.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Minor Nerve e.g. inactivity or injury producing Injury/Inactivity adherences between nerve & sheath. Minor minor injury involving the bone and Osteochondral cartilage tissue usually in a joint injury Muscle Sprain/ Grade 1 involves small number Tear of muscle fibres, causes localised pain and no

loss of strength. Grade 2 tear of significant number of fibres with associated pain & swelling. Pain on muscle contraction, strength reduced & movement limited.

Grade 3 complete tear of muscle most commonly seen at musculotendinous junction.

Neurapraxia pertaining to the conduction (praxi) of

electrical impulses along nerve pathways. Osteitis inflammation of the bone tissue. Osteoarthritis non inflammatory joint degenerative disease

with degeneration of articular cartilage, degeneration of bone at margins, changes in synovial membrane.

Osteochondral pertaining to bone (osteo) and cartilage

(chondral). Paratendinitis inflammation of tendon & nearby (para)

tissue. Periosteitis inflammation of the periosteum. Periosteal Contusion a bruise to the periosteum or bleeding within

the periosteum without breakage of the periosteal ‘skin’

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Puncture wound wound caused by piercing or penetrating tissue with a pointed object or instrument.

Stress Fracture a break in the continuity of bone tissue caused

by a long term, continuous activity i.e. tibia, fibula, lumbar vertebrae.

Subluxation incomplete or partial dislocation. Synovitis inflammation of synovial membrane

(fluctuating swelling of joint as in rheumatic fever, rheumatoid arthritis, trauma, gout etc.)

Tear complete or partial break in the continuity of

soft tissue. Tendinitis inflammation of tendons & tendon & muscle

attachments. Tenosynovitis inflammation of tendon & synovial fluid. Eg

knee joint. Tendinosis disease of the tendon (osis-disease). Traumatic Bursitis inflammation of a bursa due to damage

produced by an external force. e.g. shoulder injured through contact sport (football).

Vascular pertaining to blood.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Foot/Ankle Joint/Calf

Typical Complaints Plantar Fasciitis Sprained Ankle Achilles tendon Causes of Injury to this Area Main Muscles affecting the function of this Area Muscle Action of Muscle Gastrocnemius Soleus Peroneus Longus Tibialis Anterior

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Muscle Action of Muscle Tibialis Posterior Plantaris Testing Range of Movement for this area Passive/Active/Resisted

Dorsiflexion Plantar Flexion Eversion Inversion

Special tests Suggested General treatment strategy Warm-up from waist down (anterior and posterior). Include feet. Scan for associated problems in pelvic region etc Specifically treat relevant muscles with LG & BCF, CFF (to attachments, ligaments and tendons), DIP to muscle belly & attachments.

Suggested Calf Massage treatment

The knee should be flexed to some degree with the foot plantar flexed comfortably.

- Stroking and kneading to the calf muscles - BCF with two hands if practical 3 x 3 - BL in strips through the calf - Origin- Medial and lateral head of gastrocnemius beside and below the knee joint. Soleus arises more laterally along upper tibia and posterior fibula. CFF, PR and DIP. - Insertion- work is directed around the Achilles tendon. - Try and pick up the calf muscles and work away from the bone for a stretch effect. - Full relaxation of the gastrocnemius and soleus absolutely essential for deeper calf work.

Anterior Calf The shape of the anterior aspect of the lower leg is not conductive to nice flowing strokes. Specific CFF, PR and DIP can be applied along the lateral border of the anterior tibia and laterally through the musculature if the muscles are involved.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Lower Leg

Typical Complaints Compartment Syndrome Shin Pain Causes of Injury to this Area Main Muscles affecting the function of this Area Muscle Action of Muscle Biceps Femoris Semi tendinosis Semi membranosis

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Testing Range of movement for this Area Knee Flexion Medial rotation of leg Suggested General treatment strategy Warm up from waist down to scan for associated problems in pelvic & upper Legs region looking at anterior & posterior. Specifically treat relevant muscles with LG & BCF, CFF (to attachments, ligaments and tendons) DIP to muscle belly and attachments

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Knee & Upper Leg Area

Typical Complaints Knee Conditions Hamstring Injuries

Quadratus Injuries Causes of Injury to this Area Main Muscles affecting the function of this Area Muscle Action of Muscle Gastrocnemius Rectus Femoris Vastus Lateralis

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Muscle Action of Muscle Vastus Medialis Vastus Intermedius Sartorius Gracilis Biceps Femoris Semitendinosus Semimembranosus Testing Range of Movement for this Area Knee Flexion Knee Extension Thigh Flexion Thigh Extension Lateral Rotation Thigh Medial Rotation Thigh Suggested general treatment strategy Warm-up through lower thoracic, lumbar to scan for associated problems (anterior and posterior) in lower back and pelvic region. Specifically treat relevant muscles with LG & BCF, CFF (to attachments, ligaments and tendons) DIP to muscle belly and attachments.

Posterior Thigh Work in this area should be performed with the knee supported in some degree of flexion to enhance relaxation of the hamstrings Hamstrings -Warm up using stroking and kneading techniques

-Longitudinal strokes 3 x 3 -BFC using double hands 3 x 3 in and out -B L x3

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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(The following techniques can be can be performed with the knee supported at 90 degrees of flexion) -Repeat BCF using leading thumb -CFF with crossed thumbs in strips through hamstrings -Origin- Work the tendinous mass below the ischial tuberosity CFF and PR -Insertion- CFF and PR to lower'/4 each side of the knee.

-PR/CFF/DIP techniques through the remainder of the muscle. With the hip slightly externally rotated and abducted the hamstring relaxation will be increased for pick up and stretching.

Anterior and Medial/Lateral Thigh Stroking and kneading to front of thigh Quadriceps -BL 3 x 3

-BCF, 2 handed and leading thumb, 3 x 3 -Origin- Superior musculotendinous junction of rectus femoris and possibly

Sartorius. -Insertions- PR and CFF to superior aspect of the patella -Vastus medialis- PR and CFF around the origin and through the bulk of the muscle Pick up and examine the lower medial aspect of the muscle. -Sartorius- follow the line of the muscle using PR and CFF and flowing strokes where possible. -Remainder of Quadriceps- Leading thumb techniques, PR and CFF. -Apply DIP techniques where appropriate throughout the muscle and pick up when possible.

Lateral thigh -Broad pressure and possibly double thumb techniques to lateral aspect. Any techniques aimed at correcting problems in this area will by necessity include the posterolateral hip. (The ilio- tibial band forms part of the gluteal and tensor fascia lata insertions).

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Pelvic Girdle – Anterior & Posterior

Typical Complaints Adductors (Groin Injuries) Lower Back Pain Sciatic Syndrome Causes of Injury to this Area Main Muscles affecting the function of this Area Muscle Action of Muscle Erector Spinae Latissimus Dorsi Quadratus Lumborum Psoas/Iliacus

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Muscle Action of Muscle Tensor Fascia Latae/ITB Gluteus Medius Gluteus Maximus Gluteus Minimus Rectus Femoris Hamstrings Adductors Gracilis Sartorius Rectus Abdominus Short Rotators (Piriformis) Testing Range of Movement for this Area Spinal Extension Spinal Flexion Lateral flexion spine Hip flexion Hip extension Abduction femur Adduction femur Medial rotation femur Lateral Rotation femur Knee flexion

Humerus Adduction/internal rotation/hyperextension

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Suggested general treatment strategy Warm-up whole back and upper legs, anterior & posterior to scan for associated problems. Specifically treat relevant muscles with LG & BCF, CFF (to attachments, ligaments and tendons) DIP to muscle belly attachments.

Adductors Because of the inherently sensitive nature of this area work should only be performed with an explanation and justification to the client.

Care of the patients modesty is absolutely paramount.

-The thigh should be abducted and the hip flexed slightly in a supported position. - Avoid pressure on the femoral triangle -BCF 3 x 3 and BL 2 x 3 from proximal to distal. -Origin and insertions techniques involve working from the medial side of the knee, along the inside of the femur, high into the groin. Origin work into the groin should only be performed if directly implicated in symptoms and with the patient's full, unreserved co-operation. -Pick up and work to the adductors. Leading thumb techniques are useful in conjunction with PR, CFF and DIP.

Basic Back Techniques In this section we will be focusing on a sequence directed at the erector spinae musculature. Remember- -The erector spinae muscle mass decreases caudo-cephally

-Working on the thoracic component involves the pectoral girdle muscles -Working on the lumbar spine involves latissimus dorsi.

Stroke sequence -Warm up the whole back using kneading, BCF and BL from the opposite side. (Three passes of each) -Then double handed BCF from the same side x3 and BL x 3 on both the thoracic and lumber sections. -Mentally divide the lumbar E/S into 3 and the thoracic into 2 -Using one hand and a leading thumb perform CF x3 and BL following the strips -Double thumb CF- 2-3 runs on each strip. Origin and Insertion -PR and CFF applied to sacral and iliac origins.

Superficial CFF along the sides of the spinous processes Any isolated blocks of tightness can be worked top and bottom and then PR/DIP/CFF techniques through the tight area.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Progression to deeper techniques can continue as tolerated. Deep longitudinal techniques can be performed using- -Trailing/leading pisiform

-Supported elbow -Guided knuckles -Broad hand with leading thumb -Double thumb techniques

Some of these can also be modified for CF work. As a culmination of deep work DIP and CFF can be applied to the deep postural muscles along the posterior aspect of the vertebrae at each level.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Thoracic

Typical Complaints Thoracic Back Pain,

Indigestion (Hernia) Pain, Pain between the scapulae

Causes of Injury to this Area Main Muscles affecting the function of this Area Muscle Action of Muscle Erector Spinae Splenius Latissimus Dorsi Trapezius Rhomboids Levator Scapulae Serratus Anterior Teres Major

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Muscle Action of Muscle Teres Minor Pectoralis Major Pectoralis Minor Testing Range of Movement for this Area Spinal Extension Humerus Adduction/internal rotation/hyper extension Lateral flex neck Retract Scapulae Elevate scapulae Depress scapulae Suggested general treatment strategy Warm-up whole back including buttocks, anterior and posterior thoracic area, pectoral girdle and neck. Scan for associated problems. Specifically treat relevant muscles with LG & BCF, CFF (to attachments, ligaments and tendons), DIP to muscle belly and attachments. Pectoral Girdle Techniques- Posterior- Warm up -Broad circular kneading to the posterior aspect of the pectoral girdle.

-General BCF -BL to thoracic erector spinae

Latissimus Dorsi -Light BL across ribs x3

-Heavier pressure following ribs -CFF Superficially in the lumbar spine for origin -Pick up, kneading and examination of the distal portion -PR and DIP

Trapezius -BL 3 x 3 superficially

-BL x 3 Superficially -Origin- PR and CFF just lateral to spinous processes Tl2- T1. -General pressure C7- base of skull and external nuchal line. -Insertion- Upper edge of "anatomical horseshoe” CFF and PR. -Deep slow pressure through lower portion of the muscle with DIP.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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-Pick up and examine upper portion. BCF and DIP between "anatomical horseshoe" and cervical spine (possibly with the shoulder slightly elevated and retracted).

Rhomboids -BL 3 x 3 deeper

-BFC x3 deeper between vertebrae and medial border of scapula. -Origin- PR and CFF T1- T5 just lateral to the spinous processes. -Insertion- PR and CFF to attachment on medial scapula border (just off edge with pressure away from the scapula).

Levator Scapulae -BL x3 through the crook of the shoulder (upper trapezius and levator

scapulae) -BCF 3 x 3 -Origin is accessible to work with sufficient relaxation of the scapula (CFF and DIP). -Work on the levator scapulae can also be performed in side lying with the side to be treated uppermost.

Winging the scapula -Shoulder girdle held in supported retraction and slight elevation to enable

better access to inner scapula muscles for BCF and DIP techniques. Manual Stretching can also be performed by exaggerated winging of the scapula.

Anterior- Warm up -Therapists corresponding arm hooked under patients arm to keep it out of

the way and take the stretch of the muscle tissue to be worked. -Male- broad stroking and kneading to the chest musculature. -Female/Male- firmer kneading of upper muscular component. N.B. with female patients it is usually appropriate to have their opposite hand placed over breast on the side being worked. This places the person in charge of their own modesty and prevents inadvertent contract.

Pectoralis major- Origin- CFF and Pr to sternal and clavicular attachments

-Insertion- PR to distal musculotendinous junction -Pick up and examination of distal portion (Dip and CFF)

Pectoralis minor- (Side lying or supine) lift pectoralis major across and away from the body

to gain better access to the deep pectoralis minor. -Work upward carefully from its origins on ribs 3-5 examining and working fibres to the insertion at the coracoid process.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Neck

Typical Complaints Neck pain/wry neck

Headaches Scalenes Sternocleidomastoid

Causes of Injury to this Area Main Muscles affecting the function of this Area Muscle Action of Muscle Erector Spinae Splenius Trapezius Rhomboids Levator Scapulae Scalenes Sternocleidomastoid

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Testing Range of Movement for this Area Cervical spine flexion Spinal Extension

Lateral flexion of neck Rotate neck Protract scapula Retract Scapulae Elevate scapulae Depress scapulae Suggested general treatment strategy Warm-up whole back including buttocks, anterior & posterior thoracic area, pectoral girdle and neck to scan for associated problems. Specifically treat relevant muscles with LG & BCF, CFF (to attachments, ligaments and tendons), DIP to muscle belly and attachments.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Shoulder

Typical Complaints Shoulder problems Causes of Injury to this Area Main Muscles affecting the function of this Area

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Muscle Action of Muscle Trapezius Rhomboids Levator Scapulae Supraspinatus Infraspinatus Teres Minor Subscapularis Latissimus dorsi Pectoralis Major Pectoralis Minor Deltoid Other muscles that cross shoulder joint you should consider Biceps Triceps Coracobrachialis Testing Range of Movement for the Area Elevates scapulae Flexes humerus Extends humerus Lateral flexion neck Protract scapula Retract Scapula

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Testing Range of Movement for the Area Depress scapula External rotation of the humerus Internal rotation of the humerus Abduction of the humerus Adduction of the humerus Stabilise the head of Humerus Suggested general Treatment strategy Warm up upper back, anterior & posterior thoracic area, pectoral girdle, neck and upper arms to scan for associated problems. Specifically treat relevant muscles with LG & BCF, CFF (to attachments, ligaments and tendons). DIP to muscle belly and attachments.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Arm

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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Typical Complaints Tennis elbow Golf Elbow Carpal tunnel Causes of Injury to this Area

Main Muscles affecting the function of this Area Muscle Action of Muscle Biceps Triceps Coracobrachialis Brachioradialis Extensors of forearm Flexors of forearm Testing Range of Movement for the Area Elbow flexion Elbow extension Wrist extension Wrist flexion Suggested general treatment strategy Warm-up upper back, anterior & posterior thoracic area, pectoral girdle, neck and arms and hands scan for associated problems. Specifically treat relevant muscles with LG & BCF, CFF (to attachments, ligaments and tendons). DIP to muscle belly and attachments.

© 2004 MCPT Deep Tissue Techniques (Massage 3) – Certificate IV in Massage HLT 40302

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BABY MASSAGE Massage is touch. Touch is one of the first senses we develop as babies. We explore through touch. As we get older we express ourselves and show we care through touch. BENEFITS OF MASSAGE.

1. Stimulates circulation. 2. Helps venous flow return to heart. 3. Increases the supply of nutrients to muscles and organs. 4. It has been proven that it stimulates the growth hormone in babies. 5. Increases mobility. 6. Relaxation.

PREPARATION 1. Timing - in between feeds when the baby is neither full nor empty and is awake.

2. Warmth - babies lose their body heat 10 times faster than adults so make sure the room is

warm and cosy.

3. Nice surface - large soft towel or blanket. 4. Atmosphere - phone off the hook.

- door locked - complete attention - gentle music

5. Oils -

a. Cold pressed vegetable oils, as they are light and easily absorbed and they don't block up skin pores - almond, grape seed, coconut.

b. Light perfume as babies are very sensitive to smells. Use a small amount of oil and then add an essential oil that is required for baby’s special need.

c. Warm oil by putting it in a bowl of hot water (out of reach of waving arms). d. Pour oil onto hands first and then apply to baby's skin.

6. Positions - Sitting with baby on lap. - Sitting with baby facing you leaning on your bent knees. - Sitting on haunches - baby on mat in front of you. - Standing with baby on table.

7. Bath - have a warm bath ready for baby to relax in after massage. 8. Sing, talk and play games while massaging to make it fun and pleasurable. 9. Relaxing hands - if you are tense the infant will sense this. a. Rubbing hands. b. Wriggling hands. c. Shaking hands. d. Shoulder shrugs.

e. Simultaneously massage forearms, upper arms, and shoulders.

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10. Practice by using fingertip pressure - if that is OK for the baby use more of the hand. Always make sure hands are relaxed - don't exert force, the pressure is just the weight of the hands. Follow the contours of the body.

11. Don't attempt to massage if -you are unwell. -upset / distracted / stressed. -he/she is not interested. MASSAGE 1. Place baby on soft surface. Relax hands and oil them. Gently place hands on shoulders.

Thumbs should be resting on breast bone. Move thumbs across the chest to side of rib cage.

2. Move hands down the shoulders and upper arms, gently squeeze upper arms and forearms and across hands.

3. Move back to shoulders and repeat the sequence but instead of squeezing gently move down the arms in a flowing movement.

4. Gently massage palms of hands and fingers.

5. With arms around the sides of the baby’s lower rib cage, move them down and inward

pressing gently into the soft walls of the tummy. Be careful to avoid the navel if it hasn't healed. Do include genitals as part of the massage, not over-emphasising them or ignoring them.

6. Gently massage lightly in a clockwise direction over tummy.

7. If navel has healed, place hand on the tummy and gently rock the lower body to and fro.

This will help to relax the tummy. Never force the tummy massage.

8. Gently stroke down the legs following the contours of the thighs, knees, calves and feet. You can massage both fronts and backs of legs.

9. Gently play with feet and toes. 10. Lay baby on tummy. He/she might find a cushion underneath tummy is more comfortable. Stroke down to buttocks with both hands. Now trying one hand at a time. 11. Using light circular movements massage lower back and buttocks. 12. Massage buttocks in circular movement with fingertips. During the massage talk and sign to the baby. Sometimes it is good to tell the baby about the birth. Any of the sequences can be done as long as the baby is enjoying them. Also this is only a guide so you can experiment with different strokes. Vary the touch, speed etc. to suit yourself and the baby.

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If the baby doesn't feel happy about a full routine just do bits and pieces. Massaging feet and hands can be very relaxing when the baby is unsettled. Massaging down the body is relaxing. Massaging up the body is stimulating. Some suggestions for baby: REMEMBER that order and technique are not important; your touch and baby's enjoyment is. If baby doesn't like a particular stroke, leave it out or improvise a similar one of your own.

Kneeling with baby on his/her back and lying on your knees, stretch the arms gently keeping them in line with the shoulders as they swing forward and backward. This may be done in a standing position, baby taking a little weight.

Lying baby in front of you on his/her back, the legs can be stretched. You can stroke the legs at the same time.

Rub, squeeze, stroke the feet; play with the toes. Stroke across the chest, over shoulders and down the arms. Don't forget the hands. Turn baby over and stroke up the back and around the neck and shoulders. There is only one massage pressure for infants - LIGHT. Do not persist with movements which are not liked. Make the massage a game. ENJOY.

MASSAGE FOR PREGNANT WOMEN.

DO' S Pillows for comfort and support. Lay on side when pregnancy is advanced to discomfort stage. Gentle pressure and usual strokes. Awareness of own posture is important. Communication - verbal. Environment - warmth, light, music.

DON'TS

Not on stomach if uncomfortable. Minimum pressure on stomach. Be tactful. Care with lower back massage, especially in early and the last stages of pregnancy or depending on medical conditions.

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Where to now? This module is an introduction if you like to Remedial massage. The skills you have learnt here will last you a lifetime. If you want to go further with your studies, there are many opportunities to complete them. Whilst we hope you stay with the MCPT, there a wide range of reputable (and not so reputable schools) out there for you to choose from. You need to consider the following when choosing your course: 1. Is the course at Diploma level or above? The minimum standard should be a Diploma level. This is generally the standard needed to join massage associations and receive Workcover/health fund accreditation. 2. Is the course run by a government accredited institution? Whilst this is not critical, government accreditation gives you the surety that the training institution has some standards to maintain and your qualification will be recognised Australia-wide. Also, check that the institution and the course are accredited. 3. Does the length/cost of training seem too good to be true? Sometimes ads are placed, claiming that you can gain a Diploma of Remedial Massage in 2 weekends! Buyer beware. The minimum length of training for a Diploma level course is 900 – 1000 hours. 4. Is the course taught predominately by video/open learning? Whilst there may be some justification in learning this way, you do need to be disciplined and focused. As long as there is some attendance at classes, your learning should not be hindered. Doing a full course by video etc is not the best way to learn, and most reputable associations will not accept you as a member. MCPT offers the following courses: Diploma of Remedial Massage course code HLT50302

Therapeutic/Relaxation /Swedish massage is typically a smooth, flowing style of massage, specifically designed to relax muscular tension and in turn relax clients. Deep Tissue massage in some respects is an inaccurate term. Any style of massage, if performed properly, is a “Deep Tissue” massage. Remedial Massage is a results focused style of massage. A Remedial Therapist will assess specific problems and treat the muscle groups/area using a variety of modalities or techniques. Common terms used are Trigger Point Therapy, Myofascial release, Muscle Energy Technique, Positional Release Technique etc.