Myofascial Therapies

Tonight is our Myofascial Therapy (MFT) Test. We have been assigned two body parts of which we will be tested on. We need to do an assesment of our client, create a strategy based on our assesment, do the work - include one PNF Stretch, reassess and then educate and rebook the client. The body parts I was assigned are Neck and Wrist/Elbow.

Client's Assessment:

Kiva (client) comes in and mentions she has some issues with her neck and left arm. She is a bartender - she lifts heavy things and makes a lot of mixed beverages with a shaker. She typically uses her left hand/arm more than her right.

My Assessment as a Massage Therapist: - Let's work on each body part that Kiva is here for individually for now and in the end we can make a full assessment of the trouble areas.

Neck:

POSTURE: In a postural view, Kiva's neck has a slight lateral flexion to the right. This more than likely means her SCM, Scalenes, Levator Scapula, Upper Traps, Erector Spinae muscles are all contracting (shortening) and rather tight on the RIGHT. We want to work on the Agonist Muscles (target muscles that are creating the tight, short contracted area) when finding a postural issue. The muscles we would want to work on are the muscles stated above, but on the RIGHT side of the neck. You would want to do some simple warming of the fascia and then do a little Longitudinal Release (LR) to lengthen the muscles and Cross Fiber (CF) to break up any adhesions. We use a "Slack, Sink and Stroke" method or "Sawing" which is sinking and stroking.

ROM: After going through a couple different ranges of motions (ROM), I noticed that Kiva has "within normal limits (WNL)" ROM in everything but Lateral flexion of her neck to the LEFT. For the test, we would call this: "Decreased ROM when the neck is laterally flexed to the LEFT." Whenever you are working with ROM, you will work on the Antagonist muscles (Over stretched or overly tight areas that are limiting and preventing normal ROM - this is typically the muscles on the oposite side of where you find the decreased ROM). For example, since Kiva has decreased ROM to the left, that would mean that her RIGHT SCM, Scalenes and etc. are the muscles that are tight and limiting the ROM of the neck to laterally flex to the left WNL. So with that said, we would want to do some Longitudinal Release (LR) on the RIGHT side (muscles recognized above) to lengthen those tight and shortened muscles to allow for normal ROM when she laterally flexes her neck to the left. Some Cross Fiber (CF) would be a great way to break up any adhesions that might be causing some limited ROM as well. I would also recommend a lateral flextion PNF (Proprioceptive Neuromuscular Facilitation) stretch to the left allowing the muscles on the Right to lengthen. (feel free to comment if you need more clarification on this stretch).

Wrist and Elbow:

POSTURE: In a postural view, Kiva's LEFT elbow is slightly Flexed compared to her right elbow. Same as above, we would work on the Agonist muscles that help to flex the elbow (which are the Biceps Brachii). We will want to do some LR and CF to lengthen muscles and break up adhesions that may be causing her to hold her elbow in a flexed position.

ROM: After performing multiple ROM's we found that Kiva has pretty good ROM over all but we did see some choppiness durring PRONATION. As I mentioned above, we want to work on the Antagonist Muscles when we have a ROM issues and "Choppiness" is considered a ROM issue. That would mean that we would work on the Biceps Brachii (supinator) on the LEFT arm. We will perform LR and CF again to lengthen the muscles and break up any adhesions we may find.

REASSESSMENT: After all the work is done, I would reassess by having her go through the ROM's again to see if the body work helped to lengthen and stretch out the areas we worked on to see if there was any change.

Overall assesment possibility is that due to Kiva's Left arm usage for shaking and mixing up drinks, it could be over time causing her issues with her flexed elbow, Supination ROM and causing her to laterally flex her neck to the right to compinsate for her left arm doing all the shaking. It might be an intersting suggestion to have her try shaking drinks with her right arm and see if that changes her Decreased ROM and Postural Flexation to the right. This may allow her to lengthen the muscles on the right side all by herself. I will also recommend a few different stretches she can do on her own and that she come back to see me in a week so we can reassess and work on any further issues, tension or pain that she might have.

Accupressure Tip for the Day - "Weight Loss":

Apply steady, penetrating finger pressure to each of the following points for 1 - 3 minutes.

1. We'll Begin with 'Appetite Control' ear point. This appetite control point can help you avoid overeating.

Appetite control point is located in your ear. While looking in a mirror, place your fingers on your jaw, in front of your ears. Open and close your mouth a few times until you feel your jaw bone moving underneath your fingers. Put one finger where you feel the most movement of the jaw. Your finger should be right next to a little fleshy protrusion of the ear (not the ear lobe). Grab this part of the ear with your thumb and index finger and press with steady pressure.

2. Spleen 6 (Sp 6) has a strengthening effect on the digestive system. This point is located on the inside portion of your leg, above the ankle bone. From the center of the ankle bone, slide up four finger widths. The point is just off the bone, toward the back of the leg. When you find it, press with your thumb or knuckle. Increase pressure until you are pressing quite firmly, hold about a minute, and gradually release.
Caution: Do not press this point if you are pregnant.

3. Stomach 36 (St 36) is the best point to nourish the chi and blood. It has a beneficial effect on the digestive system. St 36 is located four finger widths below the lower border of the kneecap and one finger width off the shin bone to the outside. You've found the point correctly if you feel the muscle move under your fingers when you flex your foot up and down. Using moderate to firm pressure, hold for about one minute.

4. Spleen 9 (Sp 9) This point is a close neighbor of St 36. After pressing St 36, slide your finger across the shinbone until you are just off the shinbone on the inside side of the leg. Now slide your finger upwards along the shinbone towards the knee about an inch, until you fall into a natural depression. Sp 9 is in this depression, right below a rounded prominence in the top of the leg bone (tibia). This point is involved with the regulation of water metabolism in the body.

5. Stomach 40 (St 40) An important point for clearing excess damp and phlegm. It is also useful for eliminating excess weight.

SMASHING You ask? SMASHING You get!

I have recently been told that I have a calling in "SMASHING". Some of you may ask what that is? It is a very intense but rejuvenating massage for anyone in need of deep, heavy pressure. Most ideal for intense athletes. It is performed on the floor or mat using my body weight to slowly walk on the belly of one's legs, butt and back muscles...arms can also be done but in a lighter more moderate manor - however Myofascia Release is better recommended for the arms. You will get more of a Cross Fiber (breaks up muscle adhesions) and Longitudinal Release (lengthens tight or tense muscles) during this massage. Pressure can be altered at anytime with a slight shift of weight through my body movements. I work with your pain scale and apply the amount of pressure I think you will need to truly feel your muscles release and relax.

I am currently creating an hour long session that is sure to keep you coming back. Mr. Kelly Starrett, Owner of San Francisco CrossFit and Physical Therapist has become a regular client of mine. He is assisting me in the creation of this hour long SMASHING session. I will keep you posted on my launch date. As of right now I am performing Specific Body SMASHING along with Myofascia Release and Shiatsu. My massage session hours are from 9:30am - 12pm on Saturdays at San Francisco CrossFit behind Sports Basement. If you would like to sign up for a half hour massage, please email me and I will be happy to add you to the list (first come first serve basis- CrossFitters and Spouses Only at this time). Half Hour Sessions are free of charge for the time being but tip is always a great way to make sure your name is on the list next week or the week thereafter!

My next post will be on Anatomy and Physiology along with a couple Stress Management Tips! I will end my post today with a nice one...

If you are feeling Angry, Frustrated or Irritated apply pressure to the following two Acupressure Points:
1) GB 20 - in the hollow below occipital ridge, both sides. Hold it as long as 90 seconds.
2) GB 21 - highest point on shoulder line midway between shoulder tip and spine (c7)- Where the finger is pointing to on the photo below. Hold as long as 90 seconds.

Have a great Monday!