A treatment depends on the condition or ailment and application of massage received. First time appointment clients should wear lightweight, loose fitting clothing for an assessment to be performed. This shouldn't take more than 5-10 min. For the treatment a towel is ALWAYS used and securely draped for the massage. This is not only for the comfort of the client but rather respect for the Therapists' work ethics. An assessment will be taken and a case history form will be filled out, this is only coinciding with the severity of the case.
An assessment could consist of one or several of the following:
Nerve innervations are essential knowledge when dealing with muscles that is why these tests are imperative. It enables you to determine where the pain initiated and at what level of the spinal column. (Also; impingement, disc herniation or prolapsed)
After treatment a remedial exercise is given pertaining to observations and assessments.
This involves movements to perhaps mobilize strengthen, and/or stretch.
These exercises may be given to isolate a specific muscle or compensating muscles to affected areas.
Range of Motion
After a massage treatment, sometimes the Therapist will work with a specific muscle or compensating group, to help the specific ailment that was treated (by stretching /range of motion). A home remedial exercise is often given to the client pertaining to observations and assessments in the case history. This will help the client perform actively, on their own, regain mobility by strengthening and stretching.
Active, Passive and Resisted range of motions are performed by the Therapist and the client. This will help determine strength, weakness or obstructions, involving pain, in order to help in the designated treatment plan.
Isometric and isotonic contractions may be performed as well to help in isolating the muscle.
The Therapist observes certain anatomical structures, bony landmarks, misalignments or abnormal lumps. It is also important for the Therapist to have knowledge of any sensitive areas, (i.e., ulnar nerve next to the medial epicondyle of the humerus; peroneal nerve close to the head of the fibula). (There's nothing worse than that therapist running over one's "funny bone")
Plumbline/Postural Abnormalities Gait
This is when the Therapist observes the body's mechanics and the effects of the force of gravity. A plumbline assessment is simply presenting the body in vertical planes.
Note is taken of any postural deformities or deviations that could be present (muscular or structural).
While the client is standing, a fixed point is set to the vertical position and an anterior, lateral and posterior view are observed, (i.e.: head, clavicles, ribs, waist, elbows hips, knees and ankles).
One's gait is extremely important. Quite often any pain is not recognized or discomfort experienced, and could be a result from the way one walks. The Therapist should observe the way the shoes are worn; (and whether the client is excessively inverting or everting).
We have a gait cycle, 60% is stance phase and 40% is the swing phase.
We break it down into the different components (deceleration, midswing, acceleration, pushoff, midstance, footflat, and heelstrike).
Throughout the components, observations are made at which muscles are concentrically and eccentrically contracting, and at which stage. Several problems can be determined through this assessment that contribute to the pain, involving lowback, hip, foot and knee problems.
Quite often, clients question the fact of the pain being experienced. Is it simply muscle soreness from an overuse injury, or could there actually be a serious neurological problem? (i.e., disc, ligament, or nerve impingement, etc.). This is why orthopedic testing is so important and takes only a few minutes out of the treatment plan.
While the Therapist instructs and assists the client, certain tests can be performed to determine the cause. Results in finding a positive test can explain why one may be feeling a certain ache or discomfort. This in turn will locate the precise problematic area. i.e., Sciatic---positive Straight Leg Raise
Meniscal Tear--positive McMurrays
Tendonitis for long head of biceps-Speed's Test
For other tests pertaining to specific conditions see section on Individual Ailments
The Therapist performs touch and scratch tests, to find tenderness related to it's nerve root distribution off of the spinal column.
A dermatome is an area of skin that is supplied with it's own nerve fibers.
A myotome is a group of muscles innervated from a single spinal nerve root, i.e., C5 anterior arm / forearm
L3 medial/anterior thigh
Motor Reflex Testing
A nerve off of the spinal column innervates every muscle in the body. When a limb moves, a muscle is flexed. Any type of movement, is the result of the brain sending messages to the spinal column, telling the muscles to move. It is at each specific level of the vertebral column that the nerves come off and enable the muscle to move.
For example the quadriceps muscle, it's muscular nerve innervations are L2, L3 and L4. Its action is to extend the knee and flex the hip. If a client is suffering from any type of paralysis in this muscle, the Therapist knows where its blood and "motor" supply come from at that specific level of the vertebral column.
This is why motor tests are imperative. It enables the Therapist to determine where the pain is initiated and at what level of the spinal column (also; impingement, disc herniation or prolapse).
The therapist resists an action performed actively by the client. Specific muscle movements are involved when these tests are performed, this ensures that the muscle is receiving the message from the brain-spinal column. i.e.;
C5 resisted abduction (deltoid)
C6 resisted flexion (biceps) / resisted wrist extension (extensor digitorum longus)
C7 resisted wrist flexion (palmaris longus )
C8 resisted finger flexion (flexor digitorum superficialis)
L4 resisted dorsiflexion (tibialis anterior)
T1 resisted finger abduction/adduction (interossei)
S1 resisted eversion (peroneus longus)
Deep Tendon Reflex
This is a reflex action or movement of the client when the Therapist slightly taps the specific tendon. This will test the nerve supply of specific roots off of the spinal column, making sure the message is sent to the spinal cord and being relayed back to the muscle. i.e.,
C5 biceps tendon
C6 brachioradialis tendon
C7 triceps tendon
L4 patellar tendon
S1 Achilles tendon
Forces, Responses And Endfeels
When the client performs different movements there are different controlled forces that stretch, bend and twist, such as bone, nerve, ligament, or muscle.
It is important for the Therapist to observe a variety of things upon the movement of the client such as: the amount of effort, location, direction, frequency and speed of application.
When the Therapist performs range of motion (passive) towards the end of the range, there will be some resistance. This is called an "end-feel". There are normal and abnormal end-feels. i.e., bone-to-bone, soft tissue approximation and tissue stretch
Spasm, empty, capsular, springy and boggy are Endfeels felt by the Therapists and observed in the assessment to differentiation between sprains, strains, torn menisci and simply "loose joints".
Pain and its attributes
It is essential for the Therapist to acknowledge and take note of the client's pain. Several questions are asked and occasionally to be described in more detail on the case history form. The reasoning for this is it will enable the Therapist to determine the origin.
When does the pain occur?
What type of pain is experienced (local or referring)?
What is the level of intensity?
What aggravates / relieves the pain?
Are there any other symptoms associated with the pain?
Are you receiving any treatment now (medication)?
Pain can result from pathology of muscle, joint, ligament, bone, nerve or viscera.
There can be many onsets either insidious or sudden.
i.e.; joint clicking, decreased range of motion, weakness, aggravations and joint crepitis.