Sequences

Posterior Leg

  • Upper Leg

  • Draping Procedure

    • The undergarment should be taken high enough that it rests on the Anterior Superior Iliac Spine (ASIS).

    • The greater trochanter and part of the gluteal area needs to be exposed.

    • Anchor top of the sheet above Greater Trochanter

    • Angle edge of sheet from anchor medial across upper thigh

    • Elevate limb slightly & draw sheet under limb on angle superior & later toward GT

  • What to Check for Prior

    • Contusions (Bruising)

    • Varicose Veins

    • Rashes, Broken Skin

  • During Application

    • Monitor for any isolated section of W4-W5

  • General Sequence

    • Three Passes of the Following

      • Effleurage Entire Leg

    • Upper Leg

      • Effleurage

      • Friction

      • Petrissage

    • Lower Leg

      • Effleurage

      • Friction

      • Petrissage

    • Foot

      • Effleurage to the ankle & sole of the foot

      • Friction sole of foot

    • Entire Limb

      • Tapotement

      • Nerve Stroke

Anterior Leg

  • Draping

    • Anchor top of the sheet above Gt

    • Angle edge of sheet from anchor medial across the upper thigh

    • Elevate the limb slightly & draw the sheet under the limb on the angle superior & later toward GT

  • General Sequence

    • Three Passes of the Following

      • Effleurage entire leg

    • Upper Leg

      • Effleurage

      • Friction

      • Petrissage

      • Scissoring of Rectus Femoris

      • Passive Patellar Movement

    • Lower Leg

      • Effleurage

      • Friction

    • Foot

      • Effleurage ankle & foot

      • Friction tarsals, metatarsals, phalanges, & sole of foot

      • Passive Ankle Movement

    • Entire Limb

      • Tapotement to Upper Limb

      • Nerve Stroke

  • Note

    • Picking up may be added at the end of the application

    • Continue strokes over GT

    • Feet may be done with the anterior leg or you can do them at the end of the massage- NEVER skip them unless the client requests

Hips & Back

  • Draping

    • Back shoulder remain covered for warmth

    • Cover back with a towel

      • Pull sheet from under & position with rib at the iliac crest

    • Anchor the sheet at ASIS

      • Roll ribbed edge of sheet under the garment band

    • Pull one side down to below the inferior aspect of GT

      • Assure Gluteal Cleft is not exposed

  • Massage of Hips

    • Effleurage

      • Directed commence from below GT upward & moved upward over the iliac crest into the lumbar

      • Alter application as you proceed to be more lateral over crest & GT

      • Avoid separation of Greater Gluteal Cleft

    • Friction

      • Around

        • GT

        • Illiac Cret

        • Sacrum

        • 2cm Below Crest

        • Line Traveling from GT to Sacrum

    • Petrissage

      • Thumb Rolling; in Fan Shape

      • Wringing

        • Commense over GT

      • Following petrisage, effluerage the area & reposition sheet 7 move to opposite hip

  • Massage of Torso

    • Efflerage

      • Upward from illiac crest & upward over scapula

      • Strokes should curl at the end over the acromion process ease pressure before returning

      • Lateralization may be incoprorated with the strokes traveling from the spine laterally

    • Friction

      • Low Back

        • Illiac Crest

        • 12th Rib

        • Lumbar Veterbral Structures

      • Length of Back

      • Shoulder

    • Specialized Frictions

      • Erector Spinae Scissoring

        • Use of thumbs

      • Transvere Frictioning

        • Along Intervertebral Sulcus

      • Push & Pull

        • Combination of Friction & Pettrisage

    • Petrissage

      • Rolling

      • Wrining

        • Applied over Lumbar & Erector Spinae

      • Trap Squeezing

    • Tapotement

      • Hacking & Cupping

      • Avoid:

        • Kidneys

        • Spinous Process

        • Veretbral Border of Scapula

        • Spine of Scapula

    • Nerve Stroke

Arms, Pectorals, & Abdomen

  • Order of the Massage via Manual

    • Arms, Pectoral, Abdominals, Neck

Common Dysfunctions of the Shoulder/Arms

  • Shoulder Dislocations

    • Overview:

      • The shoulder (glenohumeral joint) is the most common dislocation site due to its structure- large humeral head & shallow glenoid fossa

    • Precaution:

      • Do NOT position arm over client’s head; runs the risk of another dislocation

    • Signs & Symptoms

      • Swelling, bruising, discoloration

      • Abnormal joint shape

      • Symptoms: LOM, pain during movement, numbness, tingling

  • Bursitis

    • Overview:

      • Inflammation of the bursa; fluid filled sac which reduces friction between tissues

    • Causes:

      • Repetitive minor impacts or serious injuries.

      • Aging: Tendons become less elastic and more prone to tears.

      • Overuse or improper posture during activities

    • Signs & Symptoms

      • Pain & Severe LOM “Adhesive Capsulitis”

    • Application

      • Massage can help drain tissues, reduce pain, and improve mobility using techniques like friction and ice massage

  • Tendonitis

    • Overview:
      Tendinitis is inflammation or irritation of tendons, often caused by overuse or overload. Tendons connect muscles to bones and vary in size.

    • Causes:

      • Overuse: Repeated motions.

      • Overload: Rapid increase in activity intensity.

    • Signs & Symptoms:

      • Pain around the affected joint, often after excessive use.

      • Weakness, redness, swelling, and warmth in the area.

    • Other Considerations:
      Infections (e.g., gonorrhea) causing tendonitis may present with additional symptoms like rash or fever

  • Specific Types

  • Shoulder Tendonitis

    • Most Common Form: Rotator cuff tendonitis, primarily affecting the supraspinatus tendon.

    • Cause: Overuse, often in jobs or sports requiring repeated arm elevation (e.g., carpenters, painters, swimmers, tennis players).

    • Typical Patient: Male labourer over 40, with pain in the dominant-side shoulder

  • Elbow Tendonitis

  • Lateral Epicondylitis (Tennis Elbow):

    • Symptoms: Pain on the outer side of the elbow.

    • Cause: Overuse, common in racquet sports or activities involving repeated wrist twisting (e.g., using a screwdriver, pulling weeds).

    • Prevalence: Affects 40-50% of adult racquet sport athletes.

  • Medial Epicondylitis (Golfer's Elbow):

    • Symptoms: Pain on the inner side of the elbow.

    • Cause: Overuse, often in occupations requiring repeated elbow movements (e.g., construction work) or sports like golf or baseball.

    • Less Common than tennis elbow

  • Wrist Tendonitis

  • De Quervain's Disease:

    • Symptoms: Pain in the back of the wrist at the thumb base.

    • Cause: Repeated thumb grasping or pinching, sometimes linked to pregnancy or unknown factors.

  • Lower Extremity Tendonitis

  • Jumper's Knee (Knee Tendonitis):

    • Location: Pain below or above the kneecap.

    • Cause: Overuse, common in basketball players and runners.

  • Achilles Tendonitis:

    • Location: Pain at the back of the heel or 2-4 inches above it.

    • Cause: Overuse in running or jumping sports, improper running technique, or poorly fitting shoes.

    • Other Factors: Can be linked to inflammatory conditions (e.g., gout, rheumatoid arthritis).

    • Prevalence: Accounts for 15% of running injuries.

  • Carpal Tunnel

  • Cause:

    • Pressure on the median nerve in the wrist passes through the carpal tunnel alongside tendons.

  • Function of the Median Nerve:

    • Controls movement and feeling in the thumb, index, middle, and half of the ring finger (not the little finger).

  • Causes of Pressure:

    • Swelling due to illnesses (e.g., hypothyroidism, rheumatoid arthritis, diabetes).

    • Repetitive hand or wrist movements, especially with bent wrists.

    • Pregnancy.

  • Symptoms:

    • Tingling, numbness, weakness, or pain in the hand or fingers (excluding the little finger).

    • Pain may extend from the hand to the elbow.

    • Symptoms are often noticed at night and may improve by shaking the hand.

  • Indicator:

    • Symptoms isolated to the thumb, index, middle, and half of the ring finger (not the little finger) may suggest carpal tunnel syndrome.

  • Other Possible Causes:

    • Wrist injury.

    • Dysfunction in the neck or compression of the median nerve along its path in the arm

Massage of the Arm

  • Draping

    • Begin in supine with sheets fully covering both extremities & torso. Expose the arm by pulling back the sheet on one side. Once exposed, use one hand to elevate & the other to draw the edge of the sheet back through the axilla

  • Upper Arm

    • Effleurage: Entire upper arm to warm tissue

    • Friction

      • Deltoid origin (Scapular spine, Acromion Process, & Lateral Clavicle)

      • Lateral Humerus (Deltoid Insertion)

      • Greater Tubercle of Humerus & Medial Humerus (Tricep origin & insertion at olecranon process)

    • Petrissage:

      • Rolling & Wringing

  • Forearm

    • Effleurage: Warm the forearm while stabilizing the upper arm on the table in a slightly externally rotated position. Secure the client’s wrist

    • Friction

      • Anterior and posterior surfaces of the radius and ulna.

      • Anterior and posterior interosseous membranes (six total paths).

      • Lateral and medial epicondyles of the humerus (C-clamp style)

    • Effleurage: Repeat over the forearm

    • Petrissage: Rolling (place forearm between your hands & roll) & wrining

    • Effleurage

    • Tapotement:

      • Use hacking & pounding

  • Hand

    • Effleurage: Focus to the palm

    • Friction:

      • Apply to the wrist, carpals, and spaces between the metacarpal bones.

      • Perform bone shaking on the metacarpals.

      • Follow with a couple of effleurage movements

    • Petrissage

    • Effleurage

    • Passive Movement

      • Stabilize the radius and ulna with one hand.

      • Grasp the client’s hand at the proximal end of the metacarpals.

      • Apply traction and move the wrist passively through:

        • Flexion and extension.

        • Abduction and adduction.

      • Repeat with gentle passive movements in all directions.

Pectorals

  • Draping

    • Ensure only the chest is exposed

    • Note: Manual states males chests may be fully exposed; not applicable in class

  • Pectroals

    • Effleurage:

      • Use long strokes starting from the lower abdomen, traveling up the torso, and curling off over the shoulders.

    • Friction:

      • Along the clavicle and sternum.

      • Pay special attention to the coracoid process (avoid irritation).

      • Apply friction between the intercostal spaces.

      • Follow with effleurage.

    • Petrissage:

      • Use rolling techniques over the pectoral region, starting from the lateral torso.

      • Work on one side at a time to cover the entire area.

    • Tapotement:

      • Apply light finger flicking only.

    • Completion:

      • Finish with effleurage.

Commons Dysnfunctions & Facts of Abdominals

  • Acute Abodominal Pain

    • Acute Pancreaitis

    • Appendicitis

    • Cholecytis

    • Gallstones & Bile Duct Stones

    • Perforated Gastric or Duodenal Ulcer

    • Rupertered Aortic Anerysm

    • Sudden Loss of Blood

    • Sudden Obstruction of Intestine

    • Females: Ruperted Ectopic Pregnancy or Ovarian Cysts

  • Chronic Abdominal Pain

    • Chronic Pancreaitis

    • Constipation & Diarrhea

    • Diverticulitis

    • Gastrisis

    • Gastroesophageal Reflux Disease

    • Inflammaory Bowel Disease

  • Landmarks of Abdomen

  • Right Upper Quadrant

    • Liver, Stomach, Gallbladder, Kidney, Heart

  • Right Lower Quadrant

    • Appendix, Colon, Ovaries

  • Left Upper Quadrant

    • Stomach, Spleen, Pancreas, Kidney

  • Left Lower Quadrant

    • Colon, Rectum, Ovary

Stomach Massage

  • Draping:

  • Using Sheet

    • Place an additional towel over the client, ensuring the arms and entire thoracic cage are covered.

    • Hold the towel in place while gently pulling the sheet out from underneath it.

      • The client can assist by holding the towel steady.

    • Expose the abdomen down to the anterior superior iliac spines (approximately 3-4 cm below the navel).

    • Let the sheet drape over the table’s edge to secure its position

  • Using Towels

    • Overlap two towels at abdominals

    • Pull back the upper towel to expose upper abdomen

    • Gently pull tower towel to reveal lower abdomen

  • Two Stages

  • First Stage: Addresses superficial musulatue of the abdomen that includes Obliques & Rectus Abdominus

  • Second Stage: Addresses depper organs contained in abdomen