Clinical Massage 1 Midterm

Why stack your thumbs when you can look at this stack of flashcards?

Describe a referral pattern

When or how pain radiates from a trigger point.

What are some descriptions a client could use to describe a referral pattern?

Radiating

Tingling

Numb

Achy

Tight

Local

A twinge

What are the two main techniques this class teaches?

Trigger point therapy

Cross fiber friction

What is the intention behind clinical work?

To reduce and/or relieve a patient’s symptoms and increase tissue health and quality

What are some physiological changes the tissue will experience from clinical massage techniques? (There are 7 total)

1. Increased blood flow 

2. Increased ROM

3. Increased lymph drainage/flow

4. Increased strength/endurance

5. Decreased symptomology

6. Decreased compensation

7. Decreased chance of reinjury

What is a latent trigger point?

It doesn't fire on its own and can become an active trigger point

What is an active trigger point?

It fires on its own and has a referral pattern

What are the main 5 posterior neck muscles?

1. Trapezius,

2. Splenius Capitis,

3. Posterior Cervical Muscles,

4. Suboccipitals,

5. Splenius Cervicis

List the four suboccipital muscles. 

1. Rectus capitis posterior minor

2. Rectus capitis posterior major

3. Obliquus Capitis Superior

4. Obliquus Capitis Inferior 

List some muscles whose referral pattern could duplicate the symptoms of a headache. 5 total

Traps

Suboccipitals

Posterior cervical muscles

Splenius Capitis

Splenius Cervicis

What are 5 things known about trigger points?

1. They exist

2. Create discomfort/pain/symptomology

3. Can affect any soft tissue structure of the body

4. Caused by some type of injury/abuse to the muscle or soft tissue structure

5. Are treatable with specific massage techniques

What’s “our” definition of a trigger point?

A Hyperirritable spot within a soft tissue structure that is associated with a hypersensitive palpable nodule surrounded by tight fibers.

What are some soft tissue structures that can form trigger points? 7 total

1. Muscles

2. Tendons

3. Ligaments

4. Fascia

5. Periosteum

6. Scars

7. Joint capsules

4 factors of TP formation

1. Formed when soft tissue is abused in some way (injury, compensation, overuse)

2. Age

3. Tissue health

4. Overall health

What’s the definition of a referral?

Any type of a sensation that the client feels somewhere in the body. Is often familiar to the client.

What does a referral look like?

The sensation often refers away and outward from the TP

What are 2 referral fascinations?

1. Most muscles have predictable patterns of referral/sensation

2. TP referral patterns are distinctive to themselves. They don’t follow nerve pathways, meridians, dermatomes, etc.

What is a central trigger point?

Located in the center of muscle fibers, the muscle belly

What is an attachment TP?

Located at the attachment of the muscle to the tendon, or the attachment of the tendon to the bone

What is a key TP?

Responsible for the formation of other TPs

What is a satellite TP?

TPs that form in response to key TPs. Located in the referral zone of the key TP

What are some effects of TP on the tissue?

1. 1. The taut fibers (bands)

   1. a. Keep a constant pulling or tension in the muscle’s attachments, which can also affect the joints

   2. b. Decreases the tissue’s ROM

   3. c. Keeps muscles in a tight and weakened condition, affecting strength and endurance.

2. Metabolic process of the tissue is compromised: circulation, waste disposal, decreased oxygen and nutrients, etc

3. Characteristic referral pattern

4. Non-uniform tissue consistency

5. Local twitch response

6. Can create a pattern of compensation

There is a direct relationship between the level of t___ of the trigger point and the s___ of the client’s s___. The more h____ the trigger point is, the greater the client’s s____.

Tenderness | Severity | Symptoms | Hyperirritable | Symptoms

What Increases Trigger Point Symptoms?

1. Use of the muscle/soft tissue structure

2. Stretching – especially active

3. Direct pressure to the trigger point

4. Weather changes

5. Shortening of the muscle for extended periods of time (postural or positional)

6. Sustained repetitive contraction of the muscle

7. Stress

4 perpetuating Factors of Trigger Point Formation

1. Nutritional inadequacies

2. Metabolic/endocrine inadequacies

3. Physiological factors

4. Illness

How does a trigger point relate to the client’s symptoms?

1. The referral pattern is familiar to the client and matches the description of the client’s symptoms

2. When we press the trigger point, we duplicate the client’s symptoms

3. As the trigger point melts away the client’s symptoms diminish.

What Decreases Trigger Point Symptoms:

1. 1. Massage therapy

2. Short periods of activity followed by rest

3. Slow, steady, passive stretching of the soft tissue structures

4. Ice/cold

5. Heat

Treatments of Trigger Points:

1. Trigger point pressure release

2. Spray and stretch: Vapocoolant sprayed unilaterally while passively stretching the area

3. Injection: Local anesthetic, procaine, saline, lidocaine

Describe the difference between a Trigger Point and a Tender Point

Trigger point has a referral pattern, which is usually in a distal direction

Tender point does not have a referral pattern, but it is tender for the client when pressed.

____ is about being in the right ____ and the right ___

Location, place, time

____ is when you should only work as ___ as the tissue allows

Depth, deeply

What’s our range for Optimal Tolerance?

5-5.5/10

What are the benefits of working slowly?

Helps us feel the tissue, anatomical structures, and change in the tissues.

What’s the definition of CFF?

A back and forth movement across the fibers using consistent pressure in both directions of the sweep

What’s CFF’s intention?

Spread out or separate the soft tissue fibers of adhesions from each other

What type of tissue does CFF address most effectively?

Areas of tissue that feel “too stuck together.” Thick, matted, dense

What creates thick, matted, and dense tissue?

1. Injury/trauma

2. Overuse/overload

3. Compensation

What is tenosynovitis?

Inflammation of a tendon with a sheath

CFF Principles

1. Location x 3

a. Find the right spot(s)

b. Focus work on the thicker, denser areas of tissue

2. Consistent pressure

3. Therapist’s fingers and client’s skin move together as one unit across the tissue or structure. Don’t just move the skin around

4. Direction: across the fibers

5. Sweep size: ½ to 1 inch long

a. May vary according to the size of the area and/or therapist’s hand

Hand positions for CFF

1. Fingertips:

   1. a. Use 2 or 3: Index, middle, ring. Depends on size and space to work

2. Index over middle finger, or middle over index

3. Pincer grip

a. Opposing fingers and thumb: not a pinch.

i. Using a rolling motion

4. Thumb stacked on top of thumb

What are some differences between healthy and unhealthy tissue?

Healthy:

1. Not tender to light/moderate pressure

2. Uniform tissue consistency: Tissue palpates as loose, flexible, elastic, movable, supple, etc.

3. Muscle contracts when instructed by an impulse, but is able to return to its original resting length.

Unhealthy:

1. Tender when using light/moderate pressure – hurts.

2. Has a non-uniform tissue consistency: palpates as tight, ropey, thready, congested, boggy.

3. Muscle contracts when instructed by impulse, but isn’t able to return to its original resting length once the contraction is turned off.

What can unhealthy tissue feel like?

Congested

Boggy

Spongy

Tight

Ropey

Stringy

Thready

What are some soft tissues we will address?

1. Muscles

2. Tendons

3. Ligaments

4. Fascia-connective tissue

5. Periosteum

What creates unhealthy tissue?

1. Injury/trauma: Sprains, strains, broken bones, surgeries, severe bruising, etc.

2. Overuse/overload: Chronic abuse and/or a constant low-level load of strain.

3. Compensation/adaptation: The involvement of the synergistic and antagonistic soft tissue structures that weren’t involved in the original injury.

4. Nutrition

5. Lack of exercise/stretching

6. Emotional components/stress

7. Disease

8. Medications

What are some differences between acute, sub-acute, and chronic

Acute: Last for a short duration of time. Sharp, severe, intense. Occasionally felt.

Sub-acute: Continues to diminish as tissues heal, transitions from sharp to dull

Chronic: Dull, mild or severe, present for over 3-6 months

What is a syndrome?

A collection of symptoms

What is our overall goal with clinical therapeutic massage?

Bring the body back into a state of balance

Creating healthier tissue

Reduce the patterns of distortion

Reduce the patterns of dysfunction