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.

The Anatomy of Low Back Pain

Understanding the anatomy of the lumbar spine is key to understanding and managing low back pain.

The lumbar spine, commonly called the “low back”, consists of 5 vertebrae, and is located between the thoracic spine (which articulate with ribs) and the sacrum. The vertebrae themselves are given numbers by which they are identified, for example – Lumbar Vertebra 1 = L1, Lumbar Vertebra 2 = L2 and so on.

The normal lordotic curve of the low back is known as a secondary curve, and starts to develop in infancy due to weight bearing caused by learning to sit up and walk.  The low back is especially vulnerable to injury due to its weight bearing task and mobility.

Between each vertebrae throughout the whole spine (except for C1 and C2) is a intervertebral or fibrous disc. The purpose of the disc is to provide cushioning and shock absorption from weight bearing and movement. The intervertebral disc is comprised of the annulous fibrosis and the gel-like centre called the nucleus pulposus – these structures are work together to provide the shock absorption, and are both implicated in disc dysfunction and neurological symptoms.

Facet joints are the articulating surfaces of bone between vertebrae. These synovial joints are known as “plane” joints because their flat surfaces glide over each other. These joints may become inflamed due to injury to the joint or joint capsule itself, or due to compression of the intervertebral discs, forcing them to interact in a “close-packed” position. This close packed position means that the joint surfaces are forced closer together than normal, and will irritate the bone and cartilage during movement as they contact each other and create friction.

During an acute injury, the inflamed tissue in the joints may irritate the nerve roots as they exit the spinal cord via the intervertebral foramina. Eventually, if facet irritation is untreated, bony spurs may develop due to chronic inflammation and cause spinal stenosis – a decrease in the size of the “vertebral foramen” or spinal canal.

In the case of a “bulging” or herniated disc, pressure is exerted on the nerve root as it leaves the spinal cord via the intervertebral foramina. This pinching or pressure on the nerve root will cause sharp, shooting pain, especially when the patient leans forward (flexes) from the hip.  Symptoms will present in the areas that the compromised nerves supply.

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

UN Climate Change Conference – Speak Up and Get Involved!

“The ultimate test of a moral society is the kind of world that it leaves to its children.” Dietrich Bonhoeffer

From December 7 to 18^th, 2009, world leaders will be meeting at the United Nations Climate Change Conference in Copenhagen to ratify the Kyoto Protocol – an agreement of 37 industrialized countries that is based on the United Nations Framework Convention on Climate Change.  The Protocol was agreed upon in 1997 in Kyoto, Japan, and entered into effect in February, 2005.

The goal of the Protocol is, in a nutshell, to hold industrialized nations accountable for reducing carbon emissions and introducing environmentally sustainable industrial practices.

In researching Canada’s contribution (or lack thereof) to the Protocol’s compliance, I was dismayed to see on the website Climate Justice (under the auspices of Friends of the Earth) that as of October 31, 2006,

“The Kyoto Protocol Compliance Committee and the Canadian Environment Minister have today been informed that Canada is violating the Kyoto Protocol and the UN Framework Convention on Climate Change (UNFCCC), thus legally requiring action under the Canadian Environmental Protection Act (CEPA) to control greenhouse gas (GHG) emissions.

According to last month’s report by the Canadian Commissioner of the Environment and Sustainable Development, the gap between Canada’s GHG emissions and its Kyoto commitments is growing: Canada’s GHG emissions in 2004 were 26.6% above 1990 levels, resulting in a gap of 34.6% from Canada’s Kyoto target of a 6% reduction by 2008-2012. Per capita, Canadians are amongst the highest emitters in the world, with the production and consumption of fossil fuels accounting for 80% of these emissions.“

As it is 2009, and the UN Summit is less than 8 weeks away, I would like to think that we have improved in the last 3 years, but somehow I have my doubts.

What I don’t understand is, that in a wealthy and prosperous country that is my home (Canada), we are failing our obligations to meet the carbon reduction targets. Climate change seems to be the elephant in the room – everyone knows it’s an issue, but so few wish to acknowledge it.  The argument I typically hear, unfortunately by some people close to me, is that enforcing the protocol, (to which we are legally bound, by the way) will hurt existing industry.

What is my opinion on this? (you knew it was coming). I say “bullshit“ – existing industry which violates the standards may slow down in the short term and eventually end, but Canada can and should be at the forefront of not only carbon emission reduction, but also the development and implementation of alternative, clean energy sources. After all, if our country built the Space Arm, how hard can it be to develop solar panels, wind energy and the like?  And think of the jobs that can be created in these industries! The economic and environmental potential is endless, and we cannot sit by and complain about how hard things are if we haven’t stepped up to the plate and acted on our own behalf and that of future generations.

I hate to think of myself and my fellow countrymen as complacent, but it appears that if we don’t recognize that we are at the 11^th hour environmentally, there is little hope for future generations. I don’t have children, but I really hate to think of my niece and the children of my friends living in an environmental wasteland that we could have prevented had we not been so lazy and complacent. How pathetic is that? And, for my American readers, don’t get high on yourselves, either. Hopefully now that Obama is in the White House, you’ll get your act together, too.

What I recommend is that you get online and check out the following links:

UN Climate Summit – Backgrounder for Canadians – read this even if you’re not Canadian but would like more information on the topic.

UN Climate Summit -  Countdown to Change
Canadians – get involved, and send a message to our Prime Minister and Leaders of the Opposition – make your voice heard NOW.

United Nations Climate Change Conference – December 7 to 18^th, 2009

For general environmental information, check out the David Suzuki Foundation website – David Suzuki is a true environmental hero.

If you don’t want to do this for yourselves, the polar bears or the planet, please do it for future generations.  Our generation might not be around to benefit in 100 years or so, but we will be remembered as the generation who had the courage to step up, make difficult choices and make a change in the face of adversity.  Wouldn’t that be a great legacy to leave?

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

Warm Hydrotherapy for Chronic Injury Pain

The use of warm hydrotherapy, also known in therapeutic massage as deep moist heat, is an excellent way to control and alleviate the pain and achiness associated with chronic injuries.

Most of us have experienced at one point or another the nagging achiness that comes with a chronic injury. Deep, moist heat is an excellent way to help control this pain as a part of homecare, and is also used pre-massage treatment to prepare and warm up the tissues.

Often when an injury has been long-standing, previously damaged muscle fibres have been replaced with tough collagen fibres, aka scar tissue, which reinforce and strengthen a muscle that has been damaged. Collagen fibres do not have the blood vessels that muscle has, and this avascular quality means that decreased blood flow in this tissue interrupts or decrease cell metabolism, oxygen delivery and metabolic waste removal. While scar tissue development is a normal part of the healing process, when collagen fibres are laid down, the muscle becomes more inelastic – unable to elongate and then return to its original length. This affects not only the comfort of the client, but also the power and strength of the affected muscle.

The goals, therefore of deep moist heat in the form of a hydrocollator or thermaphore are:

-         to warm up an area by increasing blood flow
-         increase the delivery of oxygen and nutrients to muscle cells, and speeding up metabolic processes. This decreases pain and achiness.
-         the heat itself will decrease the viscosity of the “ground substance” in muscle tissue, allowing the massage therapist to break down any scar tissue and realign the affected muscle fibres with those of the surrounding tissue

Contraindications for using heat:

-         uncontrolled high blood pressure
-         diabetes or any conditions with neuropathies or altered sensation – the client won’t be able to tell if the application is too hot, and tissue could be damaged
-         any condition where tissue is fragile or circulation has been compromised (i.e. immediately after a cast is removed) – the circulation may be too impaired for extreme heat, so mild applications can be used until the condition of the tissue improves
-         tissue is broken (i.e. a cut, or skin condition such as psoriasis – the tissue is likely already inflamed – heat will make it worse,  and infection can be introduced)
-         metal implants – pins, plates, rods, wire – these will heat up quickly and can really injure a client
-         heat sources should NEVER be placed over major arteries or over the heart

How to use heat properly

You may have never heard of a thermaphore or a hydrocollator, but if you have used a gel pack or grain-filled bag you can heat in the microwave, these same principles apply:

-        heat should only be left on for 20 minutes maximum – any longer and the tissue can get very congested and be even more painful.  You can take it off and use it on another area, or reapply after an hour or so.
-         For hygiene and to prevent burns, the heat source should always be wrapped in a clean towel. For a gel pack (I boil mine on the stove in a cooking pot), I wrap a clean, damp dishcloth around it when it is hot, then a thicker cloth over top. I get the benefit of the moisture that way.
-         it is a good idea to do any stretching that needs to be done after a heat application – you muscles will be much more pliable and stretch more easily.
- use caution if you have taken any analgesics (pain killers), your perception of heat and pain may be off and you could get burned.
-         NEVER lie on a heat source – in the case of a gel pack, hydrocollator or grain-filled bag, it could burst from your weight and you could get seriously burned.

The use of heat in this manner is a great way to control pain from a chronic injury, as well as prepare the muscles in the area for stretching.

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

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