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- •Preface
- •How to Use This Book
- •Reviewers
- •Acknowledgments
- •Brief Contents
- •Contents
- •Pathology in Brief
- •The Middle Ages (400–1400)
- •The Renaissance (1450–1600)
- •The 18th Century
- •The 19th Century
- •The 20th Century
- •Contemporary Massage Therapy
- •Swedish Modalities
- •Deep Tissue Modalities
- •Neuromuscular Modalities
- •Circulatory Enhancement Modalities
- •Energy Modalities
- •Oriental/Eastern Modalities
- •Structural and Postural Integration Modalities
- •Movement Modalities
- •Special Populations
- •Touch Physiology
- •Massage Research
- •Interpretation of Touch
- •Integrative Medicine Centers
- •Oncology Massage
- •History of the Spa Industry
- •Medical Spas
- •Spa Massage Education
- •Education
- •Body of Knowledge
- •Scope of Practice
- •Code of Ethics
- •Standards of Practice
- •Legal Regulations
- •Education
- •Competency
- •Limits of Practice
- •Accountability
- •Ethics for the Profession
- •Conduct
- •Business Practices
- •Legal Requirements and Ethical Responsibilities
- •Professional Associations
- •Physical Boundaries
- •Conceptual Boundaries
- •Client Relationships
- •Professional Relationships
- •Anatomy
- •Physiology
- •Cellular Functions
- •Components of the Cell
- •Tissues
- •Tissue Membranes
- •Integumentary System
- •Skeletal System
- •Muscular System
- •Nervous System
- •Cardiovascular System
- •Lymphatic System
- •Respiratory System
- •Digestive System
- •Urinary System
- •Endocrine System
- •Special Senses
- •Anatomical Terminology
- •Arthrology
- •Range of Motion
- •Myology: The Study of Muscles
- •Body Movements
- •Components of Good Body Mechanics
- •Body Awareness
- •Improper Body Mechanics
- •Pathology
- •Pharmacology
- •Abnormal Conditions of Cells and Tissues
- •Integumentary (Skin) Conditions
- •Skeletal System Conditions
- •Muscular System Conditions
- •Nervous System Conditions
- •Cardiovascular System Conditions
- •Lymphatic and Immune System Conditions
- •Respiratory System Conditions
- •Digestive System Conditions
- •Endocrine System Conditions
- •Reproductive System Conditions
- •Conditions of the Special Senses
- •Word Elements
- •Translating Terms
- •Spelling and Pronunciation
- •Effective Communication and Interviewing Skills
- •Documentation
- •Subjective Information
- •Objective Information
- •Activity and Analysis Information
- •Plan Information
- •Putting the SOAP Together
- •Case Studies
- •Wellness versus Therapeutic Massage Assessments
- •Fascia
- •Compensation Patterns
- •Assessment Documentation
- •Ideal Posture
- •Anterior Postural Assessment
- •Posterior Postural Assessment
- •Lateral Postural Assessment
- •Postural Deviations
- •Feet
- •Active Range of Motion
- •Passive Range of Motion
- •Assessment of Skin Temperature
- •Textures and Movement of Soft Tissues
- •Rhythms
- •Case Studies
- •Progressive Case Study 3: Kirsten Van Marter
- •Initial Session
- •Subsequent Sessions
- •Healing Time
- •Duration of Future Sessions
- •Frequency of Future Sessions
- •Length of Treatment
- •Techniques and Areas to Include or Avoid
- •Reevaluation
- •Considerations for Self-Care
- •Hydrotherapy
- •Stretches
- •Rest
- •Nutrition
- •Body Awareness
- •Ergonomics
- •Treatment Recommendations
- •Case Studies
- •Supine Position
- •Prone Position
- •Side-Lying (Laterally Recumbent) Position
- •Determining Client Positioning and Bolstering
- •Sheet Draping
- •Towel Draping
- •Communication for Client Positioning and Draping
- •Grounding
- •Centering
- •Resting Stroke
- •Compression
- •Effleurage
- •Petrissage
- •Tapotement
- •Friction
- •Vibration
- •Flow Sequences for Different Client Positions
- •Supine: Chest, Neck, and Head
- •Supine: Arm
- •Supine: Abdomen
- •Supine: Leg and Foot
- •Prone: Back
- •Prone: Leg and Foot
- •Closing Sequence
- •Chair Massage
- •Corporate Chair Accounts
- •Indications and Contraindications for Chair Massage
- •Healing: Phase I
- •Healing: Phase II
- •Healing: Phase III
- •Pain–Spasm Cycle
- •Fascia
- •Direction of Ease
- •Lengthening and Stretching
- •Arterial Enhancement
- •Venous Enhancement
- •Lymph Drainage
- •Proprioceptive Neuromuscular Facilitation Techniques
- •Myofascial Techniques
- •Trigger Point Techniques
- •Hydrotherapy
- •Effects of Hydrotherapy

Chapter 3 / Body Systems 141
Urinary bladder
Prostate gland
Bulbourethral gland
and duct
Scrotum
gland wraps around the beginning part of the urethra. It has
smooth muscle walls that contract during ejaculation, and
the force of the contraction aids the expulsion of semen.
External Genitalia
The penis is an external genital organ that is responsible for
urination and delivering sperm into the female reproductive
tract. There are three areas of spongy tissue that fill with
blood during sexual arousal and cause the penis to become
erect. The parasympathetic nervous system can trigger erections unrelated to sexual stimulation.
The scrotum holds and protects the testes, maintaining
their temperature below normal body temperature to avoid
overheating the sperm. Muscles raise and lower the testes,
as a protective mechanism; the wrinkled scrotal skin allows
movement.
Functions of the Male
Reproductive System
The functions of the male reproductive system are to produce the male sex hormone, produce sperm that can fertilize a female’s egg, and deliver that sperm to the female.
Sex Hormone
Penis
B
External urethral opening
Figure 3-73. (continued ) (B) Frontal view. (Assets provided by
Anatomical Chart Co.)
Accessory Male Reproductive Organs
The accessory organs of the male reproductive system produce everything in the semen except the sperm. The seminal
vesicles, bulbourethral glands, and prostate gland all secrete
fluids containing sugar, vitamins, or enzymes. These components of semen nourish and activate the sperm as well
as cleanse the urethra prior to sperm delivery. The prostate
Testosterone is the male sex hormone produced in the testes. It stimulates development and maturation of the male
reproductive system, stimulates sperm production, and
also results in some secondary sex characteristics of males.
When testosterone production increases during the teen
years, males undergo some physical changes that accompany their growth: the voice deepens, the bones thicken, skeletal muscles enlarge, and more body hair grows, especially
in the axillary, facial, and pubic areas.
Sperm
Millions of immature sperm are produced daily in the testes, are pushed through the testes with peristaltic smooth
muscle contractions, and arrive at the epididymis to mature.
Mature sperm contain mitochondria to produce ATP, chemical energy. Each is equipped with a flagellum that it uses to
propel itself through the ducts and into the female, which it
can do only with energy from ATP.
Effects of Massage on the
Reproductive Systems
Massage stimulates the parasympathetic nervous system,
which increases circulation to the reproductive organs to
better deliver nutrients and remove cellular waste. Massage
also increases the production of oxytocin and serotonin,

142 INTRODUCTION TO MASSAGE THERAPY
chemicals that regulate moods and stimulate smooth muscle
contractions (as are found in the reproductive organs).
The resulting combination of increased blood flow and
chemicals to the reproductive organs can unintentionally
cause sexual arousal. Most massage schools teach students
the physiologic responses that are responsible for sexual
arousal so the students can be somewhat prepared for this
kind of situation and know how to ethically and professionally manage the situation.
Special Senses
The special senses are not contained in a singular body system. Nonetheless, there are a variety of sensory systems
that are important to massage therapy: proprioception,
vision, hearing, smell, and taste.
Proprioception
The body’s ability to recognize the location and position
of all of its parts at any time is called proprioception. This
sensory input is necessary for the body to move in a coordinated and safe manner. Proprioceptors, introduced earlier as
part of the nervous system section, can be found in the muscles, tendons, joints, and inner ear. These sensory neurons
convey information to the brain regarding body position,
muscle tone, and equilibrium. Muscle spindles are proprioceptors located in the muscles that are specifically responsible for sensing the length of muscle fibers. Golgi tendon
organs are specialized proprioceptors in the tendons that
sense tension of the muscle fibers.
Hearing
The ear and its structures provide our sense of hearing. The ear
consists of three sections: external ear, middle ear, internal ear.
The external ear includes the pinna (also called the auricle), the auditory canal, and the tympanic membrane (also
called the eardrum).
The middle ear contains the auditory (eustachian) tube
and three small bones called ossicles that amplify incoming
sound waves. The ossicles are named for their shape: the
malleus is similar to a hammer, the incus resembles an anvil,
and the stapes is shaped like a stirrup.
The inner ear is mostly a bony labyrinth of canals that
can be divided into three sections. The cochlea is located
toward the front and is the hearing center of the ear. It contains the organ of Corti, which transmits sound waves to the
brain. The vestibule is the next part of the ear, which responds
to up-and-down changes in head position and gravity. The
semicircular canals are the third portion of the inner ear, and
they are sensitive to rotational movement of the head.
Smell
Our sense of smell is made possible by the olfactory membrane toward the roof of the nose. Olfactory cells, sensitive
to chemicals, are located within the olfactory membrane.
The axons of all of the olfactory cells come together to
form the olfactory nerve, or cranial nerve I. The olfactory
nerve passes through a thin sheet of bone and then comes
in contact with the olfactory bulb. From there, the chemical
signals are converted into electrical signals and pass down
neurons, through the olfactory tract, and to the brain.
Vision
The vision system, or the eye, comprises the following primary structures:
• Cornea—the clear covering that protects the front of
the eye
• Iris—the colored part of the eye
• Pupil—the hole in the center of the iris that dilates
or constricts in response to light levels
• Lens—the clear, curved part of the eye behind the
iris that focuses light onto the retina
• Retina—a light-sensitive layer of tissue lining the
back of the eye that transmits the image to the brain
• Sclera—the white, outer layer of the eye
• Vitreous body—the spherical part of the eye behind
the lens filled with a gel called vitreous humor
• Extrinsic muscles—muscles that move the eye in all
directions
Taste
There are three types of papillae on the tongue that contain
taste buds. Fungiform papillae, located near the front of the
tongue, contain three to five taste buds each. Circumvallate
papillae are found toward the back of the tongue, and each
contains over 100 taste buds. Foliate papillae can be found
along the sides of the tongue, and they also have over 100
taste buds apiece. Each taste bud has between 30 and 100
taste receptors that transmit information to the brain.
Contrary to past teachings and popular belief, each taste
receptor is sensitive to each of the five taste sensations: bitter, salty, sour, sweet, and umami.
Effects of Massage on the
Special Senses
Massage impacts the special senses by invoking the parasympathetic nervous system response. The pupils constrict and
hearing becomes more acute.

Chapter 3 / Body Systems
is often the goal of massage therapy. Understanding the
attachment points and actions of the muscles in this chapter
Knowing the structures and functions of the body and
knowing how massage can affect these structures can help
you deliver safe and effective treatment. Massage affects the
basic unit of life and, ultimately, the organism. It also gives
you an opportunity to educate clients about how anatomical
and physiological changes affect their health and well-being.
The main function of the skeletal muscles is to create
movement, and restoration of the most functional movement
is especially important because it means you know the structures you are manipulating, both to create benefit and avoid
damage. Although massage focuses on the muscular system,
massage therapy deals with the whole body. All of the body
systems must cooperate for a person to function normally,
and the interrelationships between the body systems are a
critical part of the big picture of health. The effects of massage on the different body systems are outlined in Table 3-6.
Integumentary System
• Mechanically warms the skin with friction
• Increases circulation of blood and lymph within the skin
• Stimulates sebaceous gland secretions, which make skin more supple and pliable
• Stimulates sweat production, which cools the body upon evaporation of sweat
• Breaks down fascial adhesions in the subcutaneous layer (superficial fascia) to restore circulation and
movement to skin
143
Skeletal System
• Joint movement stimulates synovial fluid production, which cushions and lubricates synovial joints
• Increases the health of skeleton by enhancing circulation of blood and lymph to and from the bones
Muscular System
• Increases nutrition and development of muscles by enhancing circulation of blood and lymph to and from the
muscles
• Increases the excitability of muscles, making them more sensitive to nerve impulses
• Increases heat in and around muscles to loosen fascia and restore movement and circulation to the muscles
• Decreases hypertonicity in muscles and tendons
Nervous System
• Increases production of dopamine, a pain-relieving chemical involved in voluntary movement and clear thinking
• Increases production of endorphins, strong pain-relieving chemicals
• Increases parasympathetic nervous system activation
• Increases production of enkephalins, strong pain relievers involved in sensory integration
• Increases secretion of oxytocin, a chemical that increases the pain threshold, stimulates smooth muscle
contractions, decreases sympathetic nervous system activity, and has sedative effects
• Increases production of serotonin, which generally diminishes pain and appetite, regulates moods and sleep
patterns, and stimulates smooth muscle contractions
• Decreases production of cortisol, a natural anti-inflammatory produced in response to stress that can accelerate
tissue breakdown and prevent tissue repair
• Decreases substance P, a neurotransmitter that triggers the pain response
Cardiovascular System
• Increases circulation of blood in and around the area being addressed
• Reduces the symptoms of ischemia by increasing circulation to capillaries with poor blood flow
• Increases permeability of capillary walls, enhancing delivery of oxygen and nutrients
• Sustained percussion can cause vasodilation deep within the area being addressed to increase blood flow
Lymphatic System
• Increases circulation of lymph in and around the area being addressed
• Increases circulation of lymph to help the body fight germs
• Increases circulation of lymph, which increases removal of metabolic waste
• Reduces edema
continues on following page

144 INTRODUCTION TO MASSAGE THERAPY
Respiratory System
• Encourages slow, deep contractions of the diaphragm, which helps remove carbon dioxide waste via the lungs
• Percussive techniques can relieve chest congestion by loosening mucus within lungs
Digestive System
• Enhances the digestive process reflexively by stimulating the parasympathetic nervous response
• Mechanically pushes indigestible waste through the intestines
Urinary System
• Increases cellular and chemical waste excreted via urine
• Encourages constriction of the smooth muscle of the urinary bladder to eliminate more urine as a reflexive
response of the parasympathetic nervous system
Endocrine System
• Increases delivery of hormones and other chemicals as a result of increased circulation of blood
• Reduces levels of cortisol and epinephrine, stress-related hormones
Reproductive System
• Increases circulation to the reproductive organs
• Increases production of oxytocin and serotonin, which stimulate smooth muscle contractions
• Increases production of serotonin, which regulates moods
Special Senses
• Constricts the pupils
You may want to supplement this text with a book that
is dedicated to anatomy and physiology for more thorough
information. Countless anatomy and physiology texts are
available in libraries and stores; some are listed in the suggested readings section at the end of the chapter.
1. Define the following:
Anatomy
Homeostasis
Muscle
Muscle cell
Nerve
Neuron
Osmosis
Peristalsis
Physiology
Tissue
2. Describe where fascia can be found.
3. Define muscle origin and muscle insertion.
4. Identify at least 10 bony landmarks on yourself or
a partner.
5. Name the five functions of the muscular system.
6. List the structures of a whole skeletal muscle.
7. Identify at least four functions of the integumen-
tary system.
8. Compare and contrast the organization and bun-
dled arrangements of the structures of a muscle,
bone, and nerve.
9. Describe at least five of the body’s parasympa-
thetic nervous system responses.
10. Describe the difference between the stretch reflex
and the tendon reflex.
11. Name at least five different kinds of sensory receptors.
12. Describe the similarities between the venous sys-
tem and the lymphatic system.
13. Identify at least three effects of massage on the
lymphatic system.
14. Describe at least three different functions of the
respiratory system.
15. Name the five special senses.

Chapter 3 / Body Systems 145
SUGGESTED READINGS
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tions . 2nd ed. Baltimore: Lippincott Williams & Wilkins, 2010.
Ashton J, Cassel D. Review for Therapeutic Massage & Bodywork Exams . 3rd ed.
Baltimore: Lippincott Williams & Wilkins, 2011.
Balch PA, Balch JF. Prescription for Nutritional Healing . New York: Avery, 2000.
Benjamin B, Borden G. Listen to your Pain: The Active Person’s Guide to Understanding,
Identifying, and Treating Pain and Injury . New York: Penguin Books, 1984.
Biel A. Trail Guide to the Body . Boulder, CO: Books of Discovery, 1997.
Buchholz D. Heal Your Headache: The 1•2•3 Program for Taking Charge of your
Pain . New York: Workman Publishing, 2002.
Calais-Germain B. Anatomy of Movement . Seattle, WA: Eastland Press, 1993.
Chaitow L. Fibromyalgia and Muscle Pain: Your Self-Treatment Guide . London:
Thorsons, 2001.
Chaitow L. Fibromyalgia Syndrome: A Practitioner’s Guide to Treatment . London:
Churchill Livingstone, 2000.
Chaitow L, Bradley D, Gilbert C. Multidisciplinary Approaches to Breathing
Pattern Disorders . London: Churchill Livingstone, 2002.
Chikly B. Silent Waves: Theory and Practice of Lymph Drainage Therapy: An Os-
teopathic Lymphatic Technique . 2nd ed. Scottsdale, AZ: I.H.H. Publishing,
2004.
Clemente C. Gray’s Anatomy . 30th ed. Philadelphia: Lippincott Williams &
Wilkins, 1985.
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ed. Philadelphia: Lippincott Williams & Wilkins, 2000.
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ed. Philadelphia: Lippincott Williams & Wilkins, 2009.
Crowley LV, Abrams C. Physiology . Springhouse, PA: Springhouse Corpora-
tion, 1993.
Gray H, Lewis WH. Anatomy of the Human Body . 23rd ed. Philadelphia: Lea
& Febiger, 1936.
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NY: Readers Digest Association, 1987.
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Williams & Wilkins, 2003.
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Baltimore: Williams & Wilkins, 1993.
Lowe WW. Functional Assessment in Massage Therapy . 2nd ed. Corvallis, OR:
Paci c Orthopedic Massage, 1995.
Fortin J. Major Systems of the Body . Milwaukee, WI: World Almanac Library, 2002.
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Human Anatomy . Philadelphia: JB Lippincott, 1988.
Moyer C, Rounds J, Hannum JW. A meta-analysis of massage therapy re-
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12
4
Stephanie Simonson
Objectives
Objectives
After reading this chapter, you should be able to . . .
Upon completion of this chapter, the student will be
■
Name the three types of circulatory
able to:
enhancement massage
■
Describe 10 directional terms
■
Describe at least three ways to enhance the
■
Name the three main types of joints
flow of lymph
■
Demonstrate at least five pairs of antagonistic
■
Name and locate the major lymphatic ducts on
body movements on self or partner
an illustration of the skeleton
■
Demonstrate the difference between concentric
and eccentric muscle contractions
Key Terms
Key Terms
Acupressure (AK-yoo-preh-sher): a bodywork modal-
ity in which firm fingertip pressure is applied to
points along the energy meridians to regulate the
Anatomical position: Describes a person standing up,
flow of Qi
feet shoulder-width apart, arms at the sides, and palms
Acupressure points: specific points along all of the
facing forward.
meridians where the Qi can be most easily affected
Antagonist: A muscle that moves in opposition to the
by pressure
prime mover.
Contrast therapy: heat application followed by cold
Asymmetric stance (also one-foot-forward stance):
application, also called alternating therapy
Standing position in which both feet areon the ground,
Hydrotherapy: the external or internal use of water for
shoulder-width apart, one foot is in front of the other,
therapeutic use
and the back foot is laterally rotated.
Lymph: interstitial fluid leaked into the tissues via
Biomechanics: The study of how movement of living
capillaries carrying arterial blood
creatures is affected by both internal and external
Meridians: precise and orderly channels or pathways
factors.
through which Qi flows
Body mechanics: The efficient and effective use ofyour
Polarity (poh-LAIR-ih-tee) therapy: a modality in
body when performing massage.
which very light massage strokes are applied on
Concentric contraction: A muscle contraction in which
and off the client’s body to balance electromagnetic
the muscle shortens and the attachment sites of the
fields
muscle move closer together.
Re exology (REE- eks-AH-loh-jee): a modality in
Deep: Refers to something farther from the surface of
which fingertip compression is applied to reflex
the skin, or deeper inside the body.
■
Demonstrate an abdominal massage
■
Describe the function of proprioceptors
■
Name at least four benefits of reflexology
■
Name the three primary components of good
■
Demonstrate a basic reflexology treatment
body mechanics
■
Describe the Oriental concept of energy
■
Demonstrate the asymmetric stance while
meridians
leaning into a partner on the massage table
■
Describe the concept of polarity therapy
■
List at least five ways to minimize your risk
forinjury
points on the hand, foot, or ear that affect other
parts of the body
Right lymphatic duct: a major drain that collects all
Distal: Refers to something that is farther away from
of the lymph from the upper right quadrant of the
the torso, toward the fingers or toes.
body, including everything on the right side of the
Eccentric contraction: A muscle contraction in which
body above the diaphragm, and empties it into the
the distance between the muscle attachments in-
right subclavian vein
creases and the muscle effectively gets longer.
Shiatsu (shee-AHT-soo): a form of bodywork that
Inferior (also caudad): Refers to something more
uses a combination of acupressure with stretching,
toward the feet, or below.
range of motion, and massage strokes
Insertion of a muscle: The point of attachment thatmoves
Thoracic duct: a major drain that collects the lymph
most during contraction, often at the distal end.
from everywhere in the body except the right side
Joint: The mechanical structure where neighboring bones
of the head and thorax and empties it into the left
are attached, often with connective tissue and cartilage.
subclavian vein
Kinesiology: The study of human movement.
Yang (YAHNG): energy that flows down from the sun
Lateral: Refers to something farther away from the
and is associated with the active, bright, warm,
midline of the body
consumptive, and outward activities of the body
Medial: Refers to something closer to the midline of
Yin (YIHN): energy that flows upward from the earth
the body.
and is associated with the passive, dark, cool,
Origin of a muscle: The attachment on the bone or
supportive, and inward activities of the body
connective tissue structure that is more stationary
during muscle contraction.
146

Chapter 4 / Kinesiology and Biomechanics 147
Prime mover (also agonist): The muscle that performs
most of the intended movement.
Proprioceptor (PROH-pree-oh-SEP-tor): Sensory
neuron responsible for detecting body position,
muscle tone, and equilibrium.
Proximal: Describes something toward the attachment
point of the limb to the body.
Range of motion (ROM): The end-to-end distance
of a specific joint movement that is structurally
possible.
ow that you have a fundamental understanding of the
structures and functions of the body systems, it is impor-
N
tant to develop a working knowledge of how movement
occurs in the body. Once you understand how the body moves,
you will have the foundation to assess your client’s movement
patterns and design the appropriate treatment plan.
Kinesiology is the study of human movement.
Biomechanics is the study of how the movement of living creatures is affected by both internal and external factors, such as
neurological input, muscle–tendon interactions, gravity, and
physical strain on the body. Body mechanics is the efficient
and effective use of your body while performing massage. It
is important to be concerned with body mechanics for two
reasons. First, many clients have muscular and soft tissue pain
and tension as a result of poor posture, restricted movement,
or repetitive stress injuries (RSIs). Understanding how clients
have developed their pain patterns allows you to help them prevent the development of pain patterns in the future. Ask clients
about excessive or restricted movement patterns they encounter on a daily basis and how they move their body repetitively.
Their answers will provide you with information about how
the clients’ bodies have compensated as a result of these movement patterns and give you clues for target areas for massage
treatment. Second, in order to achieve longevity in your massage career, you must move your body in an efficient and effective manner to minimize the risk of discomfort, pain, or injury.
There is a lot of terminology in both kinesiology and
body mechanics. Learning and using the terms comfortably
is necessary to communicate accurately. The best way to
learn a new skill is to learn the language from the beginning,
so this chapter starts out with the terminology.
Super cial: Refers to something closer to the surface
of the skin.
Superior (also cephalad): Refers to something closer
to a person’s head, or above.
Symmetric stance (also parallel stance): Standing posi-
tion in which both feet face forward about shoulderwidth apart, hips face forward, and knees are bent.
Synergist: Assists the prime mover by contracting
at the same time to facilitate more effective
movement, also called an accessory muscle.
You will find yourself using this terminology regularly when
communicating with clients and other healthcare professionals as well for keeping accurate and professional records. These
terms are a large part of the language of massage.
Anatomical Position
The anatomical position of the body describes a person
standing up on both feet, with the feet shoulder-width apart,
arms at the sides, and palms facing forward (Fig. 4-1). The
Anatomical Terminology
As a massage therapist you will make observations while looking
at a client’s body during assessment, treatment, and documentation. This makes it important for you to know the terminology
for anatomical position, planes, directions, and body regions.
Figure 4-1. Anatomical position.

148 INTRODUCTION TO MASSAGE THERAPY
Figure 4-2. Planes of division.
(A)Frontal plane. (B) Sagittal plane.
(C)Transverse plane.
Frontal
(coronal) plane
A
anatomical position is used as a reference when describing the
locations of structures on the body. When being evaluated for
posture, clients stand in the anatomical position as a standard
reference point for present and future observations.
Sagittal
plane
BC
Transverse
(horizontal) plane
Superior
(cranial)
Planes
The anatomical position is also used in determining the
three planes of division: the sagittal, frontal, and transverse.
These imaginary planes are like thin walls that divide the
body or a specific organ into two parts, and they are used by
anatomists as a reference tool. Any kind of physical observation is made in reference to these planes.
A frontal plane (also called a coronal plane) runs vertically down the body, dividing the body into front and back
parts (see Fig. 4-2A).
A sagittal plane (SA-jih-tuhl) plane also runs vertically
down the body, dividing the body into left and right parts
(Fig. 4-2B). A sagittal plane can occur anywhere along the
body, but if it runs exactly down the midline of the body,
creating equal left and right halves, this plane is called the
midsagittal or medial plane.
A transverse plane runs horizontally through the body,
dividing it into top and bottom parts (Fig. 4-2C).
Directional Terms
Directional terms also refer to the anatomical position,
offering specific locational information. These terms are frequently used in massage therapy (Fig. 4-3).
Using the medial plane as a reference, two directional terms are generated: medial and lateral. Medial refers
to something closer to the midline, and lateral refers to
Anterior
(ventral)
Medial
Lateral
Figure 4-3. Directional terms.
Proximal
Posterior
(dorsal)
Distal
Inferior
(caudal)

Chapter 4 / Kinesiology and Biomechanics 149
something farther away from it. For instance, the ear is
lateral to the eye because it is farther away from the midline.
Bilateral is a term that means two sides. In massage,
bilateral refers to something on both sides of the body.
Amassage therapist’s session notes might include a comment
regarding bilateral temporomandibular joint (TMJ) pain,
meaning that the client has pain on both sides of the jaw.
Conversely, unilateral refers to something on only one
side of the body. Massage session notes that say a client has
unilateral TMJ pain would suggest that jaw movement only
hurts on one side.
The frontal plane is used as a reference for the terms
anterior and posterior. Although these terms are preferred
in massage therapy, the terms ventral and dorsal are sometimes used. Anterior (ventral) indicates something on the
front side of the body or more toward the front. Posterior
(dorsal) indicates something on the back side of the body or
more toward the back. For example, the nose is anterior to
the ear because it is more toward the front side of the body.
The transverse plane generates the terms superior and inferior. Superior (sometimes called cephalad) refers to something
closer to a person’s head, or above. Inferior (also called caudad)
refers to something more toward the feet, or below. The knee is
superior to the ankle because it is closer to the head.
Proximal and distal are terms that describe relative location on the extremities (limbs). Proximal describes some-
thing closer to the limb’s attachment point on the body,
and distal refers to something that is farther away from the
torso, toward the fingers or toes. For example, the elbow is
proximal to the wrist, and the wrist is distal to the elbow.
Superficial refers to something closer to the surface
of the skin, and deep refers to something farther from the
surface of the skin, or deeper inside the body. Superficial
and deep are often used in massage therapy to describe
the relative position of specific muscles in the body or to
describe the depth to which the strokes are being applied.
For example, the rhomboids are deep to the trapezius, and
compression can access tissues that are too deep to reach
with effleurage. Table 4-1 lists all the directional terms, definitions of each, and examples of their usage.
Body Regions
The body is divided into different regions for orientation
purposes. The terminology is helpful when you want to
refer to a general area of the body. Nearby landmarks are
often used as identifiers for these body regions, as shown in
Figure 4-4.
Term Definition Example
Term Definition Example
anterior (ventral) pertaining to the front side or toward the front of the
anterior (ventral) pertaining to the front side or toward the front of the
body
body
deep more internal, deeper into the body the lungs are deep to the ribs
deep more internal, deeper into the body the lungs are deep to the ribs
distal farther from the point of attachment or farther from
distal farther from the point of attachment or farther from
the torso
the torso
inferior (caudad) located lower or toward the feet the xiphoid process is inferior
inferior (caudad) located lower or toward the feet the xiphoid process is inferior
a
a
lateral
lateral
a
a
medial
medial
Posterior (dorsal) pertaining to the back side or toward the back of the
Posterior (dorsal) pertaining to the back side or toward the back of the
proximal closer to the point of attachment or closer to the torso the knee is proximal to the
proximal closer to the point of attachment or closer to the torso the knee is proximal to the
superficial closer to the surface of the skin the epidermis is superficial to
superficial closer to the surface of the skin the epidermis is superficial to
superior (cephalad) located higher or toward the head the nose is superior to the navel
superior (cephalad) located higher or toward the head the nose is superior to the navel
a
a
Remember that the body must be in anatomical position (palms forward).
Remember that the body must be in anatomical position (palms forward).
farther away from the midline or toward the sides the ear is lateral to the eye
farther away from the midline or toward the sides the ear is lateral to the eye
closer to the midline or toward the middle of the body the eye is medial to the ear
closer to the midline or toward the middle of the body the eye is medial to the ear
body
body
the nose is anterior to the ears
the nose is anterior to the ears
the fingers are distal to the
the fingers are distal to the
elbow
elbow
to the sternal notch
to the sternal notch
the spine is posterior to the
the spine is posterior to the
sternum
sternum
ankle
ankle
the muscles
the muscles

150 INTRODUCTION TO MASSAGE THERAPY
Cranial
Cephalic
(head)
(cranium)
Facial
(face)
Thoracic
(chest)
Upper
Extremity
Lower
extremity
Brachial
(arm)
Antebrachial
(forearm)
Carpal
(wrist)
Femoral (thigh)
Axillary (armpit)
Abdominal
(abdomen)
Pelvic (pelvis)
Inguinal (groin)
Phalangeal
(fingers)
Patellar
(kneecap)
A
Figure 4-4. (A) Anterior body regions.
Tarsal
(ankle)
Phalangeal
(toes)
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