Ryan Young Sport Massage

On November 20 & 21st, 2010, I had the privilege of attending the Introduction to Sport Massage workshop presented by Ryan Young, BSc, RMT, SMT (cc) at Accel Physiotherapy and Sport Performance Centre in Halifax, Nova Scotia.

I knew it was going to be a great course, as Ryan is a colleague of mine (he’s also my massage therapist), but the course content and presentation far exceeded my expectations.

The Saturday started off with an overview of Sports Massage Therapy, and how it plays a role in not only high level athletics, but also its role at junior and local levels.  The role of the massage therapist at sporting events was explained very succinctly, as Ryan himself has participated at such events as the 2010 IAAF World Junior Track & Field Championships. Later on that day, Ryan proceeded to discuss the function and application of massage therapy at various stages of competition.  This included a discussion of appropriate techniques, as well as demonstration and practice of their application.

Sunday morning started bright and early as we jumped into discussing techniques, seeing a demo, and practicing.   Later that day we discussed the psychology of the athlete, as well as poly-clinic etiquette for massage therapists.  Ryan also addressed questions about membership and candidature in the Canadian Sport Massage Therapists Association for those who are interested in pursuing certification.

(also please note that this course counts toward 8 CEU’s with MTANS)

After a full weekend I had a lot to think about, and since that time I have begun to modify some of my own treatment techniques using pointers that Ryan gave us.  Not surprisingly, anyone will respond well to these Swedish techniques, and I have found them to be very effective with my MVA (motor-vehicle accident) clients and even those in chronic pain.

Overall, I would rate this workshop and instructor 10/10 for relevance, organization, knowledge and presentation.  I highly recommend the Introduction to Sport Massage course to anyone looking to expand his or her knowledge and technical skills, even if you only ever plan on using it in your in-house clinical treatments.

On an even more exciting note, Ryan is the lead massage therapist for the 2011 Jeux Canada Games here in Halifax, and I am looking forward to hearing stories about the games, the athletes and the poly-clinic when the Games wrap up. These are exciting times for massage therapy, let me tell you!

Ryan’s website is RyanYoungSportMassage.com if you would like to contact him about setting up a course in your area. For further information on sports massage therapy in Canada, please go to the Canadian Sport Massage Therapist Association website.

Massage benefits are more than skin deep

Reprinted from the New York Times (www.nytimes.com). (link to original article at bottom of page)

By RONI CARYN RABIN
Published: September 20, 2010

Does a good massage do more than just relax your muscles? To find out, researchers at Cedars-Sinai Medical Center in Los Angeles recruited 53 healthy adults and randomly assigned 29 of them to a 45-minute session of deep-tissue Swedish massage and the other 24 to a session of light massage.

All of the subjects were fitted with intravenous catheters so blood samples could be taken immediately before the massage and up to an hour afterward.

To their surprise, the researchers, sponsored by the National Center for Complementary and Alternative Medicine , a division of the National Institutes of Health, found that a single session of massage caused biological changes.

Volunteers who received Swedish massage experienced significant decreases in levels of the stress hormone cortisol in blood and saliva, and in arginine vasopressin, a hormone that can lead to increases in cortisol. They also had increases in the number of lymphocytes, white blood cells that are part of the immune system.

Volunteers who had the light massage experienced greater increases in oxytocin, a hormone associated with contentment, than the Swedish massage group, and bigger decreases in adrenal corticotropin hormone, which stimulates the adrenal glands to release cortisol.

The study was published online in The Journal of Alternative and Complementary Medicine.
The lead author, Dr. Mark Hyman Rapaport, chairman of psychiatry and behavioral neurosciences at Cedars-Sinai, said the findings were “very, very intriguing and very, very exciting — and I’m a skeptic.”

A version of this article appeared in print on September 21, 2010, on page D6 of the New York edition.

Online edition link to article: http://www.nytimes.com/2010/09/21/health/research/21regimens.html?_r=1

What is Temporomandibular Joint Dysfunction Syndrome?

Temporomandibular Joint Dysfunction Syndrome (TMJD from herein), is a broad term that refers to the dysfunction of the articulation between the mandible and the cranium – aka the TMJ or temporomandibular joint. TMJD is not exclusively a disorder of the bony structures, but may also be a result of hypertonic muscles which affect the joint and therefore cause symptoms.

Temporo refers to the temporal bone of the cranium (skull), and mandibular refers to the mandible or jaw.

Symptoms of Temporomandibular Joint Dysfunction

In early stages there is often a clicking or popping noise when a client opens or shuts his or her mouth. As the condition progresses, there may be pain at the site, which is just in front of external auditory meatus (ear canal), the temple or the teeth. The noise or the discomfort usually presents unilaterally, however it can present bilaterally.

Poor coordination of the muscles leads to deviations in movement as the jaw opens or closes. For example, if looking in the mirror, a client may notice that when she opens her mouth, her jaw is pulled to one side.

In severe cases, the jaw may become dislocated and stuck open, and the surrounding muscles may spasm.

Who is at risk for TMJD ?

Temporomandibular Joint Dysfunction appears to occur more often in women, and in the age group of 20 – 40 years. It is common in people who have suffered trauma to the jaw and face, who have suffered whiplash (a WAD injury) or who may have had a lot of dental work or surgery. Other conditions such as excess muscle tension can lead to malocclusion, or arthritis may affect the joint.

TMJD also appears to worsen in those who have extreme postural deviations, such as scoliosis or anterior head carriage.

Anatomy of the Temporomandibular Joint

The TMJ is a hinged synovial joint, and is an articulation of the head of the mandible with the mandibular fossa and articular tubercle of the temporal bone.

Within the joint is an articular disc whose purpose is to cushion the bony surfaces during movement. This articular disc divides the joint capsule into a superior and an inferior compartment: superiorly between the disc and the mandibular fossa, and inferiorly between the disc and the head of the mandible.

The TMJ is located anterior to the external auditory meatus or ear canal, hence the ear pain in some cases of TMJD.

The mandible is suspended from the cranium primarily by the fibrous capsule of the TMJ and lateral ligament of the joint, in addition to the sphenomandibular and stylomandibular ligaments medially and inferiorly. The latter 2 ligaments serve to stabilize the joint during movement by opposing the pull of the capsule and lateral ligament.

Movement of the Temporomandibular Joint

The temporomandibular joint is moved by what are known as “the muscles of mastication”. There are 4 of these muscles, the temporalis, masseter, lateral and medial pterygoids.

The primary mover of the TMJ during opening (or depression) of the jaw is actually gravity – this is assisted by the lateral pterygoid muscle as well as the supra- and infrahyoid muscles. The lateral pterygoid is the only muscle of mastication that depresses the jaw.

The lateral pterygoid, and to a lesser degree, the masseter and medial pterygoids act to protrude the chin.

To elevate the mandible (close the mouth) the temporalis, masseter and medial pterygoid muscles contract.

To retract the chin, the temporalis and masseter contract.

Action of the disc during an opening/depressing movement of the TMJ

There are 2 movements which occur in the TMJ – first, the head of the mandible rotates anteriorly, secondly, the head of the mandible glides anteriorly as it continues to rotate anteriorly.

To open the mouth, the lateral pterygoids contract, and with the assistance of gravity, pulls the articular disc taut in the joint capsule.

As the head of the mandible moves anteriorly along the mandibular fossa of the temporal bone, the articular disc is pulled anteriorly as well, always staying between the two articulating bones. The correct end-range of this movement is at the articular tubercle of the temporal bone.

Dislocation of the TMJ occurs when the head of the mandible slips anteriorly to the articular tubercle. This may occur due to spasm of the lateral pterygoid muscle as the client opens their mouth.

Dislocation may also occur due to a sideways blow to the jaw when the mouth is open. It is not uncommon for the arm of the mandible to break instead of the actual TMJ dislocating.

Functional dislocation of the articular disc occurs when the disc is unable to move normally with movement of the head of the mandible. This dislocation may occur anteriorly or posteriorly to the head of the mandible.

An anterior dislocation can be differentiated by difficulty and pain with opening of the mouth, with the available movement being very limited. This is a result of the disc becoming compressed between the mandibular head and the articular tubercle and lateral pterygoid.

Difficulty and pain with elevation (closing) of the mandible, and a possible inability to close the mouth completely, is an indication of a posterior dislocation, where the articular disc is jammed against the posterior aspect of the joint cavity.

Failure of the disc to move properly within the joint capsule is believed to be the cause of the clicking sound which is often heard. The incorrect movement may be due to hypertonicity of the muscles of mastication, articular surface degeneration etc.

© Copyright 2010 Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

What is the study of Anatomy?

The study of anatomy refers to the study of the structures of the body.

There are various types of anatomy with which a massage therapist must be familiar. These are:

Clinically oriented anatomy
emphasizes structure and function as it relates to the practice of medicine and other health sciences

Surface anatomy
visualization of the structures that lie beneath the skin

Systemic anatomy
study of body systems

In reference to anatomy and other information a massage therapist needs to know:

Palpation is the forming clinical impression via touch. In addition to muscles and bones, pulses, reflexes, muscle contraction etc. are often palpated to get more information about a client’s condition.

Osteology is the study of bones

Massage Therapy Anatomy Review – Systems of the Body

There are 10 systems in the body.
1. integumentary system – skin and structures within it
2. skeletal – bones and cartilage
3. articular – joints and associated ligaments
4. muscular –
5. nervous – central nervous system (brain and spinal cord), and peripheral nervous system (cranial and spinal nerves)
6. circulatory – cardiovascular (heart and blood vessels) and lymphatic systems (lymphatic vessels and lymph nodes)
7. digestive or alimentary (organs associated with ingestion, digestion, absorption of food and elimination of its associated waste)
8. respiratory – air passages and lungs that supply oxygen to the body and eliminate carbon dioxide
9. urinary – kidneys, ureters, urinary bladder, urethra – which filter the blood and excrete waste (as urine)
10. reproductive – genitals and organs that are involved in reproduction
11. endocrine – glands and specialized cells that secrete horomones

Often the urinary and the reproductive systems are lumped together and are collectively known as the genitourinary system

Massage Therapists! YOU are responsible for client safety.

Every once in a while, I am reminded of how important it is to be vigilant when interacting with and treating clients. As a massage therapist, I am ultimately responsible for the safety of my client, from initial intake to homecare suggestions.

I was recently reminded of this fact a few weeks ago when I was sitting in my gym’s reception area, waiting for my spinning class to start. There is a conveniently located massage therapy clinic in my gym, and I am very pleased that one of my former students is employed there. She’s a great person, and a great therapist, so imagine my surprise when I overheard her suggest to her client that he do his homecare stretches in the shower.

Now, I distinctly remember the day when I was teaching the Remedical Exercise class a few years ago when we had this debate in class. Apparently the students had been told by another instructor to tell clients they could do their stretches in the shower. My argument against it was that stetching in the shower was a bad idea for several reasons – it’s wet, it’s slippery, and it’s very easy for people to get dizzy in the heat. As a combination of factors, this is an ultimate recipe for a slip and fall to occur.

As a matter of fact, in the article Bath Safety – Preventing Slip and Fall Accidents in the Bathroom, it is cited that

“Statistics show bathrooms can be the most dangerous room in your house. 70% of home accidents occur in the bathroom. The combination of water and smooth surfaces makes taking a bath or shower a risky proposition. Slip and falls account for over 20,000 fatalities per year in North America. It is the second leading cause of accidental death and disability after automobile accidents. Over 75% of slip-fall deaths occur to people 65 years of age or older…”

See my point? Yet I doubt that many massage therapy instructors OR even massage therapists think about this fact. Should it be common sense? ABSOLUTELY!!!!! And not only for massage professionals, but for the clients themselves. However, how many people blindly follow the advice of various health care professionals, much to their detriment? Tons of them, I know it. There may be therapists who will say “It is ultimately the client’s responsibility”, and you are right, to a point. But like I said, many clients take advice literally, trusting that their health care professional will give them the best information possible.

And “stretching in the shower” isn’t the only area that I am disappointed to see massage therapists failing the best interests of their clients. I have refused to treat clients with Congestive Heart Failure who wanted Manual Lymphatic Drainage to relieve their edema – telling me that their previous therapist “used to do it once a week”. (hint – MLD is contraindicated for CHF as it increases fluid return to a cardiovascular system that is already stressed out) I have refused to work distal to, and directly on, bulging varicose veins. Yes, I understand that varicose veins are uncomfortable, but when I explained to my client that deep pressure over clotted blood can break up the clot (clots are also known as “thrombus”) and cause an embolus, she was horrified that her previous massage therapist “used to drive his elbow along her calf muscles” to relieve the tension.

Don’t worry, I’m not just picking on massage therapists, I have seen other health care professionals take some pretty big risks with client safety and health. Notably:

1. The chiropractor who berated me for refusing to provide Swedish massage to an elderly lady with uncontrolled high blood pressure (I don’t remember the reading, but it was sufficiently high for me to recommend that she go to a doctor before heading home). Apparently the chiropractor in question was one who routinely did cervical spine adjustments on patients with high blood pressure in the 150/95 range. (OMG!!!). Huge potential for a stroke, here, people. Stressed arteries neighboring immobile joints are not good. Mobilizing this joints with a high-velocity, low-amplitude thrust – even worse.

2. The physiotherapist who performed a cervical spine manipulation on a patient without getting his consent, and without viewing the xrays first. Guess what? The client had osteophytes in his cervical spine from 2 WAD (whiplash associated disorder) injuries, and subsequently developed arthritis and osteophytes. Even worse, this manipulation damaged the nerves as they exited the spinal column, and this client now has permanent weakness, numbness and tingling in both hands, in the ulnar area.

3. Don’t even get me started on physicians who mis-prescribe or over-prescribe medication … Enough said.

I guess my main point from this discourse is that a little common sense goes a long way. For some health care professionals (ahem) the almighty dollar drives them to treat patients or clients who maybe are better off getting cleared for treatment, or for seeking other alternatives to relieve their conditions or pain.

Also, as a profession that is trying to gain legitimacy, the conduct of its practitioners needs to be held to a high standard. If we act like quacks, that is how we will be viewed. If we are trying to be taken seriously by the public and other health care professionals, then we have to step up as individuals and as a collective and do right by our clients, even if it means turning people away. We have a Code of Ethics for a reason, and need to keep it in mind for every client.

Personally, I would rather take home less money than take money from someone who may ultimately be harmed from something I did. If I think about how I would want someone to treat a member of my family, or anyone else I love, I am very comfortable in saying that in a strange way I feel good if I refuse to treat, knowing that I have had an opportunity to educate my client and assist him or her in getting the treatment which is the best for his or her circumstances. And for the record, when I explain to my clients the reason why I may alter a treatment, or forgo treatment altogether, they are generally very understanding and appreciative that I put their welfare ahead of my financial needs.

So, What are you going to do?

© Copyright 2010 Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

Get the Most From Your Massage Treatment

Whether or not you are a newbie to the massage therapy world, or a veteran, learning how to get the most from your massage therapy treatments is sometimes a bit of a mystery. As a massage therapist at a busy sports & physiotherapy clinic, and a massage therapy patient myself, here are my tips for getting the most out of your treatment.

1. Depending on the reasons you are going for treatment, be discerning in your choice of facility. If you are going for a relaxation treatment it is going to be a bit easier to find a suitable therapist and facility than if you are going for an injury related treatment. Word of mouth is a great way to get started in your search.

2. When you’ve made your appointment, be sure to arrive early, especially if you have to fill out a health history form. This ensures that you are relaxed, and that you are ready at your appointment time. (this also demonstrates respect for your therapists time, something that we appreciate.)

3. Fill out your health history accurately. Whether or not you think something is relevant, your therapist needs to know in order to provide a safe and effective treatment. This includes past surgeries and accidents, and past or present diagnosis. He or she can’t ensure your safety if the information you’ve provided is inaccurate, incomplete or misrepresented. And, on a legal note, he or she can’t be held liable if you’ve withheld or misrepresented your health information.

4. Don’t eat a large meal within 1-2 hours before getting a treatment – your body is busy digesting, and honestly, it’s just plain uncomfortable to lie on a full stomach.

5. Empty your bladder before your treatment time. Think of it this way – have you ever tried to sit through a long movie when you really have to go? Exactly, except it feels 10x worse when you’re laying on a full bladder. (trust me!)

6. Communicate with your therapist. If you are nervous or want to ask a question, it’s your right to express how you’re feeling. The same goes for your comfort level during the treatment. Personally, I want to know if there might be potential issues so I can pre-empt any confusion and establish a therapeutic relationship of trust and respect.

7. Let your therapist know if you want to talk or not. I generally take a client’s lead – if he or she speaks to me, then I respond; if not, then I keep quiet except for asking about comfort levels. If you find that your therapist is chatty, but you want to “zone out”, tell them so.

8. Understand that if you are being treated for a specific condition, compliance is important with treatment plans, homecare and remedial exercise. Since massage therapy is a passive therapy, it is only about 20% of the recovery process from injury or conditions. Follow therapeutic recommendations and you will prolong the positive effects of treatment and improve much more quickly.

If for any reason you are not happy with treatment, or don’t feel you have a good relationship with your therapist, it’s OK to find someone else. Not everyone is a perfect fit for every massage therapist, and vice versa. You are investing your time and money to achieve a result, so it’s your right to find someone who can help you achieve the desired results.

For more information, please refer to Massage Therapy Client Rights and Massage Therapy Client Obligations and Responsibilities.

© Copyright 2010
www.whymassagetherapy.com
All Rights Reserved.

Work Related Stress Can Kill

Very compelling evidence how everyday stress at work can not only make you miserable, it can also kill you. (May I suggest massage therapy for some stress relief?)

LONDON (Reuters) – (Reporting by Michael Kahn; Editing by Maggie Fox and Caroline Drees)

Work really can kill you, according to a study on Wednesday providing the strongest evidence yet of how on-the-job stress raises the risk of heart disease by disrupting the body’s internal systems.

The findings from a long-running study involving more than 10,000 British civil servants also suggest stress-induced biological changes may play a more direct role than previously thought, said Tarani Chandola, an epidemiologist at University College London.

“This is the first large-scale population study looking at the effects of stress measured from everyday working life on heart disease,” said Chandola, who led the study. “One of the problems is people have been sceptical whether work stress really affects a person biologically.”

Heart disease is the world’s leading cause of death. It is caused by fatty deposits that harden and block arteries, high blood pressure which damages blood vessels, and other factors.

The researchers measured stress among the civil servants by asking questions about their job demands such as how much control they had at work, how often they took breaks, and how pressed for time they were during the day.

The team conducted seven surveys over a 12-year period and found chronically stressed workers — people determined to be under severe pressure in the first two of the surveys — had a 68 percent higher risk of developing heart disease.

The link was strongest among people under 50, Chandola said.

“This study adds to the evidence that the work stress-coronary heart disease association is causal in nature,” the researchers wrote in the European Heart Journal.

Behaviour and biological changes likely explain why stress at work causes heart disease, Chandola said. For one, stressed workers eat unhealthy food, smoke, drink and skip exercise — all behaviours linked to heart disease.

In the study, stressed workers also had lowered heart rate variability — a sign of a poorly-functioning weak heart — and higher-than-normal levels of cortisol, a “stress” hormone that provides a burst of energy for a fight-or-flight response.

Too much cortisol circulating in the blood stream can damage blood vessels and the heart, Chandola said.
“If you are constantly stressed out these biological stress systems become abnormal,” Chandola said.

(Reporting by Michael Kahn; Editing by Maggie Fox and Caroline Drees)

Original article Study finds work-related stress can kill by Michael Kahn Tue Jan 22, 8:24 PM ET published on Reuters.com.

How Can Massage Treat Patellofemoral Syndrome Knee Pain?

Patellofemoral syndrome is a term used to describe knee pain caused by improper movement, or tracking, of the kneecap over the femur. This condition often results from muscle imbalance in the quadriceps, or thighs. Massage therapy is useful in addressing this muscular imbalance, resulting in decreased pain and increased function of the patellofemoral (knee) joint.

The patellofemoral joint specifically refers to the articulation of the femur and the patella. The patella, or knee cap, is a sesamoid bone and is located within the quadriceps tendon. The patella glides over the boney prominences of the femur, or the femoral condyles, as the quadriceps contract or tighten during extension of the knee.

The quadriceps (aka, quads or thigh muscles) is really a group of four muscles, consisting of the rectus femoris, vastus lateralis, vastus intermedius and vastus medialis. The muscular imbalance which may be one cause of patellofemoral syndrome occurs when the vastus lateralis is stronger than the vastus medialis, and pulls the kneecap to the outside of the thigh during movement. This imbalance is often seen in athletes such as runners, though it is not limited to athletes, and may be caused by posture.

Pain occurs when the quadriceps tendon tightens during movement and pulls the kneecap “off track” – meaning that the underside of the kneecap articulates improperly with the femur. If left untreated, this misalignment can cause inflammation and degeneration of the bony surfaces, eventually leading to arthritic changes.

The treatment

Massage therapy is very useful in reducing the tone and myofascial trigger points of the quadriceps, specifically that of the vastus lateralis. Trigger points in this muscle, which refer pain to the lateral thigh along the iliotibial band area, as well as the lateral knee, may contribute to altered gait. During a massage therapy treatment, the therapist will address the involved and compensating muscle groups, as well as stretching and using hydrotherapy during treatment (heat) and post treatment (ice or cold). The application of cold post treatment will assist in the reduction of inflammation in the patellofemoral joint and surrounding muscle tissue.

Another important aspect of rehabilitation is the strengthening of the vastus medialis, specifically the lower, oblique fibres medial to the patella, known as the vastus medialis oblique (VMO). By strengthening this muscle, the normal position of the patella is regained and it will interact correctly with the femur.

The duration and frequency of the treatment will depend on the presentation of the condition, and how long it has been present.

© Copyright 2010
Jodi Forsythe
www.whymassagetherapy.com
All Rights Reserved.

Low Back Pain and Disc Herniation

The discs located between vertebrae are vulnerable to injury, and can cause debilitating pain when injured.  Disc herniation most commonly affects the lumbar spine, but it can also occur in the cervical spine, and rarely, in the thoracic spine.

What is disc herniation?

Disc herniation is a term that refers to displacement of the nucleus pulposus of the intervertebral disc, due to injury or weakening of the external portion of the disc (annulus fibrosis).  The term “slipped disc” often refers to this type of injury, as does bulging disc.

There are four stages of disc herniation, with various degrees of displacement of the nucleus pulposus. The final stage occurs when the annulus fibrosis is completely ruptured and there is a complete loss of integrity of the external structure.

Pain occurs due to increased pressure on the nerves exiting the spinal cord. Symptoms such as pain, numbness and tingling will occur in the area that is supplied by the affected nerves.

How does disc herniation occur

Disc herniation most often occurs due to injury, sometimes from a seemingly innocent action such as bending over or twisting to pick something up. These actions of sudden flexion or rotation often cause an increase in pressure which forces the nucleus pulposus in a posterior (toward the back) direction.

Signs & Symptoms of Disc Herniation

If you’ve ever had an issue with a disc, it is an unforgettable experience.

1. Sudden, excruciating pain – into the legs and buttocks if the herniation occurs in the lumbar spine; into the arms and hands if the herniation occurs in the cervical spine.
2. Muscle spasm will occur in the injured area – this is the body’s protective mechanism to prevent further injury by immobilizing the area.
3. certain actions will increase pain and symptoms, such as bending forward from the hips, side bending, or twisting. As the action causes the pain, a therapist can tell where the bulge is happening by the pain distribution.

How is disc herniation treated?

Disc herniation is a condition that must be managed in the initial stages, with a focus on removing pressure from the affected nerves and pain control.  As the condition progresses, the focus turns to strengthening the supporting structures – if the herniation has occurred in the lumbar spine, core muscle strengthening will be incorporated into a rehabilitation program.

Massage therapy itself is not a standalone therapy for disc herniation – it can help with pain control and removing some of the excess muscle spasm. It must be noted that removing all of the hypertonicity (excess muscle tone) in the muscles surrounding the injured area is not wise – the excess tone in this case is used to stabilize the area, and if it is completely removed, the area can become very unstable and make the injury worse.

If the injury to the intervertebral disc is severe, the condition can become chronic and progress to degenerative disc disease.

For more information, please see The Anatomy of Low Back Pain.

© Copyright 2009
www.whymassagetherapy.com
All Rights Reserved.

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