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Appendix A
255
is possible for careless massage to exacerbate this problem if the
practitioner does not know where the impingement is.
BENEFITS: If the practitioner can identify the site of sciatic nerve
irritation, it may be possible to reduce mechanical disruption and
to create the potential for healthy nerve functioning.
Shin Splints (Chapter 8)
tWhat Are They?
The term “shin splints” refers to a collection of lower leg injuries,
including muscle injuries, periostitis, hairline fractures, and other
problems. They are usually brought about by overuse and/or misalignment at the ankle.
tHow Are They Recognized?
Pain along the tibia may be supercial or deep, mild or severe. The
pattern of pain differs with the specic structures that are injured.
tMassage Risks and Benefits
RISKS:
Some shin splint situations may contraindicate massage
until more information is gathered, or the acute stage has passed.
Compartment syndromes (discussed elsewhere) can be a serious
complication, and bone fractures need different treatment options
and healing times than other injuries.
BENEFITS: Massage therapy can be helpful to treat uncomplicated
muscle injuries around the tibia, and it can also be a useful strategy
to augment training and reduce the risk of injury to the lower leg
muscular and fascial structures.
Shoulder Separation—see Joint Disruptions
Sinus Congestion—see Sinusitis
Sinusitis (Chapter 10)
Pronunciation: sy-nus-I-tis
tWhat Is It?
Sinusitis is inammation of the paranasal sinuses from infection,
allergies, or physical obstruction.
tHow Is It Recognized?
Signs and symptoms include headaches; tenderness over the affected
area; runny or congested nose; facial or tooth pain; headache;
fatigue; and, if it’s related to an infection, thick, opaque mucus,
fever, and chills.
tMassage Risks and Benefits
RISKS:
Acute sinus infections contraindicate any bodywork that could
exacerbate symptoms. If the client has fever, chills, and other signs
of systemic infection, it is best to delay any rigorous massage until
this has passed. A client with a tendency toward inamed sinuses
may have problems lying at on a table, especially, face down. It
is important to be able to make accommodations for this problem.
BENEFITS:
Very gentle massage around the face, as long as no
infection is present, may help the sinuses to drain, and for sinus
pain to diminish. A client with inamed sinuses who does not have
an infection can benet from bodywork as long as he or she is
comfortable on the table.
Spasm, Cramps (Chapter 8)
tWhat Are They?
Spasms and cramps are involuntary contractions of skeletal muscle.
Spasms are considered to be low-grade, long-lasting contractions,
while cramps are short-lived, very acute contractions.
tHow Are They Recognized?
Cramps are extremely painful, with visible shortening of muscle
bers. Long-term spasms are painful and may cause inefcient
movement but may not have acute symptoms.
tMassage Risks and Benefits
RISKS:
Muscles in acute, painful contraction do not invite rigorous
massage on the belly; this may be more irritating or even damaging than not. Some underlying pathologies may cause muscle
cramping; these must be ruled out or accommodated if this is a
frequent event.
BENEFITS:
Stretching along with massage at attachment sites
of contracting muscles are often effective strategies for reducing
tone. Muscles that have been in involuntary contraction respond
well to massage, which can reduce residual pain and improve
local circulation.
Sprains (Chapters 8, 10)
tWhat Are They?
Sprains are injured ligaments. Injuries can range in severity from a
few traumatized bers to a complete rupture.
tHow Are They Recognized?
In the acute stage pain, redness, heat, swelling, and loss of joint
function are evident. Later, these symptoms are less extreme, although perhaps not entirely absent. Passive stretching of the affected
ligament is painful until all inammation has subsided.
tMassage Risks and Benefits
RISKS:
Acutely inamed sprains locally contraindicate intrusive
work until the inammation has subsided, but lymphatic work to
decrease edema may be safe and appropriate. Sprains can sometimes
mask symptoms of minor fractures; if symptoms are not signicantly
relieved within a few days, this possibility should be pursued with
a medical professional.
BENEFITS:
Damaged ligaments that are not acutely inamed respond
well to specic massage along with passive stretching and full use
within pain tolerance.
Strains (Chapter 9)
tWhat Are They?
Strains are injuries to muscles involving torn bers.
tHow Are They Recognized?
Pain, stiffness, and occasionally palpable heat and swelling are all
signs of muscle strain. Pain may be exacerbated by passive stretching
or resisted contraction of the affected muscle.
tMassage Risks and Benefits
RISKS:
Rigorous massage to an acute muscle injury may exacerbate
inammation and tissue damage.
256 Appendix A
BENEFITS:
Massage after the acute stage of inammation has passed
can powerfully inuence the production of useful scar tissue, reduce
adhesions and edema, and reestablish range of motion.
Tendinopathies (Chapters 7, 8)
Pronunciation: ten-dih-NOP-ath-ez
tWhat Are They?
Tendinopathies are injuries or damage to tendons and their fascial
sheaths. While it is possible for these injuries to involve acute
inammation (as indicated in the traditional terms tendinitis or
tenosynovitis), most long-term tendon injuries are related to collagen
degeneration rather than inammation. The term for this condition
is tendinosis. Tennis elbow, golfer’s elbow, Achilles tendinitis, and
rotator cuff injuries are all types of tendinosis.
tHow Are They Recognized?
Pain and loss of range of motion are often present with tendinopathies. Pain is exacerbated by resisted exercise of the damaged
muscle-tendon unit. Damage to the tenosynovial sheath may also
create pain, resistance to movement, and crepitus: a grinding texture
as the tendon moves through its fascial covering.
tMassage Risks and Benefits
RISKS: Tendinopathies with true inammation are rare, but when
they occur, bodywork is best delayed until the acute phase has
completed. An exception to this is lymphatic work, which may help
to limit some of the negative aspects of swelling.
BENEFITS:
Most tendinopathies indicate massage, which aims to help
improve the quality and function of the affected connective tissues.
Tennis Elbow—see Tendinopathies
Thoracic Outlet Syndrome (Chapters 7, 10)
Pronunciation: thor-AS-ik OUT-let SIN-drome
tWhat Is It?
Thoracic outlet syndrome (TOS) is a collection of signs and symptoms
brought about by occlusion of nerve and blood supply to the arm.
It is a typical form of nerve impingement syndrome.
tHow Is It Recognized?
Depending on what structures are compressed, TOS shows shooting
pains, weakness, numbness, and paresthesia (pins and needles) along
with a feeling of fullness and possible discoloration of the affected
hand and arm from impaired circulation.
tMassage Risks and Benefits
RISKS: Care must be taken not to exacerbate pressure on delicate
structures, either with massage or with positioning on the table.
Outside of this limitation, massage has no specic risks for clients
with thoracic outlet syndrome.
BENEFITS:
Massage that works to create space for unimpeded
blood and nerve impulse ow can have a profound positive impact
on thoracic outlet syndrome. If the problem arises from structural
anomalies, massage may not make much difference beyond temporary symptomatic relief. Muscular imbalances must be addressed
from multiple dimensions and directions to achieve lasting change.
Torticollis—see Dystonia
Trigeminal Neuralgia (Chapter 10)
Pronunciation: try-JEM-ih-nul nur-AL-je-ah
tWhat Is It?
Trigeminal neuralgia (TN) is a condition involving sharp electrical
or stabbing pain along one or more branches of the trigeminal nerve
(CN V), usually in the lower face and jaw.
tHow Is It Recognized?
The pain of TN is very sharp and severe. Patients report stabbing,
electrical, or burning sensations that occur in brief episodes, but that
repeat with or without identiable triggers. A tic is often present as well.
tMassage Risks and Benefits
RISKS:
TN contraindicates massage to the face unless the client can
guide the therapist into what feels safe and comfortable. Clients
may not be comfortable lying face-down if the face cradle of the
table elicits symptoms.
BENEFITS: Massage elsewhere to the body, especially to the neck
and shoulders, may offer great relief to TN patients.
Varicose Veins (Chapter 9)
Pronunciation: VARE-ih-kose vanez
tWhat Are They?
Varicose veins are distended veins, usually in the legs, caused by
venous insufciency and retrograde blood ow.
tHow Are They Recognized?
Varicose veins are ropy, bluish, elevated veins that twist and turn
out of their usual course. They are most common in branches of
the great saphenous veins on the medial side of the calf, although
they are also found on the posterior aspects of the calf and thigh.
Varicose veins can also develop at other locations, in which case
they have other names.
tMassage Risks and Benefits
RISKS: Extreme varicose veins, especially with compromised skin,
contraindicate any massage that might disrupt or irritate them. Milder
varicose veins locally contraindicate deep specic work, but are safe
for supercial massage as long as the skin is healthy. It is important
to note that people with varicose veins are at increased risk for deep
vein thrombosis, so massage therapists need to be knowledgeable
about both conditions.
BENEFITS:
Massage is unlikely to change or improve varicose veins.
As long as they are accommodated, clients with varicose veins can
enjoy the same benets from bodywork as the rest of the population.
Warts (Chapter 8)
tWhat Are They?
Warts are growths caused by slow-growing viral infections of keratinocytes in the epidermis.
tHow Are They Recognized?
The most common warts (verruca vulgaris) look like hard, cauliower-shaped lumps. When they grow on the bottom of the feet,
Appendix A 257
they are called plantar warts. Warts can affect anyone, but children
and teenagers are especially prone to them.
tMassage Risks and Benefits
RISKS: Warts locally contraindicate massage. The risk of commu-
nicability is low but not zero, and the growths may shed virus in
sloughing skin cells and local bleeding.
BENEFITS:
Massage has no direct benet for warts, but a client with
a history of this infection can enjoy the same benets from bodywork
as the rest of the population.
Whiplash (Chapter 10)
tWhat Is It?
Whiplash is a collective term referring to a collection of soft tissue
injuries that may occur with cervical acceleration followed by
deceleration. These injuries include sprained ligaments, strained
muscles, damaged joint capsules, and temporomandibular joint
problems. Although whiplash technically refers to soft tissue injury,
damage to other structures, including vertebrae, discs, and nerve
tissue, frequently occurs at the same time.
tHow Is It Recognized?
Symptoms of whiplash vary according to the nature of the injuries.
Posttrauma pain at the neck and referring into the shoulders and
arms, along with chronic headaches, are the most frequent indicators.
tMassage Risks and Benefits
RISKS: Acute injuries, along with those that have not been fully
diagnosed, contraindicate any but the gentlest bodywork. The risks
of exacerbating inammation or of disrupting unstable bones or
joints are important to respect.
BENEFITS:
Postacute and mature whiplash injuries can benet from
massage that focuses on restoring healthy muscle tone and movement
patterns, along with improving the quality of any connective tissue
scarring that may have occurred.
APPENDIX
s
l
p
s
o
en
k
ht blue
inae
r
t
p
e
:
eath
pp
t
Trigger Point Locations and Pain
B
Br
u
Referral Patterns
apter 6
or
ight gre
in
infer
subclavi
pectora
serratu
u
is major
osterior
avius
yellow
ht blu
258
subcl
erect
serra
or sp
us posterio
erior su
= serratus anterior
pink
= subscapularis
blue
Appendix B 259
yellow (thumb)
purple
yellow (arm)
light blue
light green
= trapeziuspink
= flexor compartment
= opponens pollicis
= infraspinatus
= pectoralis minor
= biceps
pink
dark blue
green
purple
yellow
aqua
= teres minor
= rhomboids
= levator scapulae
= extensor compartment
= supinator
= deltoid
Chapter 7:
Upper Extremity
260 Appendix B
light green (thumb)
dark blue
pink
dark purple
dark green
yellow
light green (forearm)
= adductor pollicis
= flexor pollicis longus
= serratus anterior
= deltoid
= brachialis
= supinator
= pronator teres
purple
aqua
yellow
pink shoulder and arm
pink neck and shoulder
dark blue
= teres major
= triceps
= infraspinatus
= supraspinatus
= trapezius
= subscapularis
Chapter 7:
Upper Extremity
Chapter 8:
Foot
= tibialis anteriorlight green
= extensor digitorum brevis
purple
= peroneus brevis
aqua
Appendix B 261
= gastrocnemius
blue
= soleus
yellow
= abductor hallucisgreen
= flexor hallucis brevisgreen
262 Appendix B
= rectus abdominis
aqua
= rectus femoris
pink
dark green
bright green
dark purple
= adductor magnus
= adductor longus
= psoas, iliacus
= vastus intermedius
blue
= vastus medialis
yellow
yellow
blue
Chapter 9:
= pectineus
= gracilis
aqua
yellow
dark blue
pink
purple
= rectus abdominis
= quadratus lumborum
= hamstrings
= glutues maximus
= psoas, iliacus
dark blue
= tensor fascia latae
green
= vastus lateralis
blue
= gluteus medius
aqua
= gluteus maximus
Core
Chapter 10:
Upper Pole
= frontalis
yellow
scalenes
purple
= sternocleidomastoid
blue
= digastric
green
= platysma
pink
= orbicularis oculi
aqua
Appendix B 263
pink
aqua
green
dark green
= splenius capitis
= temporalis
= upper trapezius
= lateral pterygoid
= occipitalis
yellow
= masseter
pink
= splenius cervicis
blue
= scalenes
purple
= upper trapezius
green
= splenius cervicis
blue
= splenius capitis
pink
Glossary
acetylcholine—a common neurotransmitter that, when it
attaches to a cell membrane, makes it highly permeable
to sodium.
adenosine triphosphate (ATP)—a compound that stores
and releases energy in cells.
collagen—a protein fiber found in connective tissue, carti-
lage, and bone.
elastin—a mucoprotein fiber that is elastic in nature. It is
found in pliable structures of the body, including connective
tissue, ligaments, and tendons.
endorphin—an opiate polypeptide produced in the brain that
binds to opiate receptor sites, thus raising the threshold
for pain perception.
enkephalin—an opiate polypeptide produced in the brain that
binds to opiate receptor sites and acts as a pain analgesic.
facilitated nerve pathways—routes developed within the
neural structures from areas of hyperirritation to other
segments of the musculoskeletal system.
fibrils—minute fibers located in the sarcoplasm of muscle
fibers.
interoception—any sense that is normally stimulated from
within the body, includes proprioception, hunger, digestive
upset, and others.
meridians—also known as channels. Meridians are energetic
pathways often associated with the organs. Meridians
distribute qi throughout the body.
motor unit—a single motor neuron and all the skeletal muscle
fibers that are innervated by that neuron’s axon terminals.
mucopolysaccharide—polysaccharides that chemically bond
with water. They are thick, gelatinous substances that form
intercellular ground substance. They are also found in
synovial fluids and mucous secretions.
muscle splinting—increased tonus in muscle tissue surround-
ing injury to provide protection by limiting movement.
phasic—a term applied to the muscles primarily responsible
for movement of the body through space.
qi—a Chinese word referring to the vital life force.
referred pain zone—a site within the myofascial tissues that
registers pain, numbness, weakness, or paresthesia from
a stimulus originating in another area.
reflex arcs—nerve feedback loops operating through the
spinal cord that link the sensory and motor systems.
They monitor and direct muscle actions, mostly at an
unconscious level.
sarcomere—the contractile unit of skeletal muscle.
stress–tension–pain cycle—a self-perpetuating, dysfunc-
tional cycle in which increased demand on the body/
mind system causes a condition of stress, heightening the
activity of the sympathetic nervous system. This leads to
increased muscular tension, which diminishes the ability
of the muscles to eliminate waste materials from the cells,
resulting in stimulation of nociceptive nerve receptors and
increased pain perception.
stretch reflex—sometimes called a myotatic reflex, an invol-
untary muscle contraction triggered by sudden stretching.
tensile—the ability to withstand stretching tension without
breaking.
tonic—a term referring to muscles with the primary function
of supporting the body in static positions (i.e., postural
muscles).
trigger point—hyperirritable areas in muscles where com-
pression may elicit a twitch response and/or referred pain.
valgus—a condition of the lower extremity in which the
bones deviate laterally from the longitudinal axis. Also
called bow-legged.
varus—a condition of the lower extremity in which the bones
deviate medially from the longitudinal axis. Also known
as knock-kneed.
264