Quick Tx Guide

Description

Progressive pain and decreased range of motion of the glenohumeral joint that is associated with inflammation, thickening, and shortening of the glenohumeral joint capsule.318-321 The etiology of adhesive capsulitis is unclear and the condition often resolves within 2 years.

Relevant Anatomy

Glenohumeral joint, acromioclavicular joint, joint capsule, coracohumeral ligament

Relevant Outcomes and Massage Techniques

Examination techniques - impairment

palpation pain, increased resting m tension, adhesions

postural malalignment

STTT impaired m integrity

shoulder m strength test weak

shoulder passive accessory motion test impaired joint mobility and joint integrity

ROM impaired joint mobility & m extensibility

functional limitation in overhead and behind back work, recreational & self-care activities

Relevant Outcomes and Massage Techniques

■ Increased joint mobility: direct fascial techniques, friction, myo-ascial release, rhythmic mobilization, rocking

■ Increased muscle performance: rhythmic mobilization, rocking,percussive techniques

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Decreased resting muscle tension (primary and compensatory); normalized neuromuscular tone: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascialtechnique, rhythmic mobilization, rocking, shaking

■ Normalized muscle and joint integrity; increased muscle extensibility: cross fiber and longitudinal strokes, petrissage, stripping, specific compression, direct fascial techniques, friction,myofascial release

Relevant Complementary Techniques

■ Hydrotherapy, stretching and strengthening exercises Contraindications and Precautions

■ Be cautious when treating a severe strain in the acute stage

■ Be cautious when treating a new injury. Do not work deeply if fresh bruises are present or if torn tissues have not yet developed scar tissue

Helpful Hints

■ Quick or strong eccentric contraction of taut or weakened hamstrings may contribute to strain.

■ Shortened, hypertonic hip flexors or hyperlordosis may be a contributing factor

Description

Stretching or tearing of the ligamentous structures of the lateral ankle resulting in pain, inflammation, and loss of function that is often

caused by quick or extreme supination.318-321 It has similar characteristics to a strain, but the pain and edema subside more slowly.

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Ankle and lower leg girth measurement ■ Edema

■ Ankle ligament stability tests ■ Impaired ligament stability ■ Impaired joint integrity

■ Ankle range of motion measurement ■ Impaired joint mobility

■ Foot and ankle muscle strength testing ■ Impaired muscle performance

■ Gait analysis ■ Gait dysfunction

■ Pain visual analog scale ■ Pain

■ Palpation ■ Pain ■ Edema ■ Increased resting muscle tension

■ Functional examination ■ Limitations in weightbearing work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Decreased edema: superficial effleurage, superficial lymph drainage techniques, broad-contact compression, petrissage

■ Normalized joint integrity: cross fiber friction and longitudinal strokes for ankle ligaments, petrissage, stripping, specific compression, direct fascial techniques, myofascial release

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

■ Decreased resting muscle tension (primary and compensatory); normalized neuromuscular tone: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

■ Increased muscle performance: rhythmic mobilization, rocking, percussive techniques

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

Relevant Complementary Techniques

■ Hydrotherapy, muscle energy techniques, ankle stretching and strengthening exercises

Contraindications and Precautions

■ Be cautious when treating a third degree sprain in the acute stage

Helpful Hints

■ Tissues surrounding the injured ligament and the affected area may develop compensatory patterns including hypertonicity, trigger points, and joint dysfunction.

Description || Relevant Anatomy: Semimembranosus, semitendinosus, biceps femoris

Stretching or tearing of the hamstring muscles resulting in pain, inflammation, and loss of function.

Hamstring strains are a common sports injury: soccer, football, hurdling, dancing. Age: 16-25 peak.

Occurs where the hamstrings are stretched eccentrically @ high speed, acute overstretch OR repetitive strain → disruption of muscle & fascial fibers.

History

• Sudden onset of posterior thigh pain

• @ end of beginning of activity (fatigue & lack of warm-up ↑ risk), transition from eccentric to concentric contraction ( sprinting, kicking, hurdling)

• ↑pain: sitting, walking uphill/upstairs

• ↓pain: rest, ice(acute) or heat (chronic)

Physical

Observation: possible antalgic gait, ecchymosis(bruise) if severe

Palpation: tenderness to palpation, local myospasm & tightness

ROM

AROM&PROM: Pain with any motion that stretches the damaged fiber ( Hip flex -SLR)

RROM: Pain with resisted knee flex, weak

Neurovascular

Tight hamstring may compress sciatic nerve ( 🚩important DDx)

Check distal pulse

Special test

(+)SLR for posterior thigh pain NOT shooting electrical pain (stretch damaged muscle)

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Gait analysis ■ Gait dysfunction

■ Hip and knee joint range of motion measurement ■ Impaired joint mobility ■ Impaired joint integrity

■ Hip and knee muscle extensibility testing ■ Impaired muscle extensibility

■ Hip and knee muscle strength testing ■ Impaired muscle performance

■ Pain visual analog scale ■ Pain

■ Palpation ■ Pain ■ Increased resting muscle tension

■ Selective tissue tension testing ■ Impaired muscle integrity

■ Functional examination ■ Limitations in weightbearing work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

■ Increased muscle performance: rhythmic mobilization, rocking, percussive techniques

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Decreased resting muscle tension (primary and compensatory); normalized neuromuscular tone: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

■ Normalized muscle and joint integrity; increased muscle extensibility: cross fiber and longitudinal strokes, petrissage, stripping, specific compression, direct fascial techniques, friction, myofascial release

Relevant Complementary Techniques

■ Hydrotherapy, stretching and strengthening exercises Contraindications and Precautions

■ Be cautious when treating a severe strain in the acute stage

■ Be cautious when treating a new injury. Do not work deeply if fresh bruises are present or if torn tissues have not yet developed scar tissue

Helpful Hints

■ Quick or strong eccentric contraction of taut or weakened hamstrings may contribute to strain.

■ Shortened, hypertonic hip flexors or hyperlordosis may be a contributing factor

Description

Tightness and inflammation of the fibrous ITB that may result from biomechanical abnormalities, unbalanced repetitive exercise, or

injury.318-321 It may contribute to ITB syndrome with its associated lateral knee or hip pain.

Relevant Anatomy

ITB, tensor fasciae latae, lateral tibial condyle, rectus femoris, gluteus maximus, biceps femoris

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

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■ Gait analysis ■ Gait dysfunction

■ Hip and knee joint range of motion measurement ■ Impaired joint mobility

■ ITB, hip and knee muscle extensibility tests ■ Impaired connective tissue integrity and mobility

■ Pain visual analog scale ■ Pain

■ Palpation (skin and fascial mobility) ■ Adhesions ■ Decreased connective tissue mobility

■ Postural examination ■ Postural malalignment

■ Functional examination ■ Limitations in weightbearing work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

■ Increased connective tissue mobility and integrity; decreased adhesions: cross fiber and longitudinal strokes, petrissage, stripping, specific compression, direct fascial techniques, myofascial release, friction

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Normalized neuromuscular tone: compression, deep effleurage, petrissage

Relevant Complementary Techniques

■ Hydrotherapy, ITB stretches

Contraindications and Precautions

■ Avoid exerting pressure on the vessels and nerves in the femoral triangle.

■ In the early stages of treatment, be cautious not to reduce tension that is compensating for injured tissues or stabilizing the joint.

Helpful Hints

■ ITB contracture is often associated with postural malalignment of the hip, knee, ankle, and foot.

■ Trigger points in the anterior aspect of gluteus minimus and vastus lateralis may refer pain along the ITB.

Description

Pain in the region of the common extensor origin associated with tendinitis (inflammation) or tendinosis (degeneration) of the tendons of the wrist and finger extensor muscles.318-321 It is often the result of overuse or injury.

Relevant Anatomy

Lateral epicondyle, extensor carpi radialis longus and brevis, extensor carpi ulnaris, extensor digitorum

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Elbow and wrist joint range of motion measurement ■ Impaired joint mobility

■ Grip strength testing ■ Impaired muscle performance

■ Muscle extensibility tests ■ Impaired muscle extensibility

■ Pain visual analog scale ■ Pain

■ Palpation of common extensor origin ■ Pain

■ Selective tissue tension testing ■ Impaired muscle integrity

■ Trigger point examination ■ Trigger points

■ Functional examination ■ Limitations in work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

■ Increased muscle performance: rhythmic mobilization, rocking, percussive techniques

■ Increased muscle extensibility; normalized muscle integrity: cross fiber strokes to the tendons, myofascial release, direct fascial technique, friction, petrissage, stripping, specific compression

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Deactivated trigger points: trigger point pressure release, cross fiber strokes, passive stretching

■ Normalized neuromuscular tone: compression, deep effleurage, petrissage

Relevant Complementary Techniques

■ Cyriax friction, hydrotherapy, stretching and strengthening exercises

Contraindications and Precautions

■ To avoid the risk of re-injury, ensure that acute pain and inflammatory processes have resolved prior to applying deep friction to the tendon

■ If repeated cross fiber strokes produce inflammation, end with cool or cold local hydrotherapy

Helpful Hints

■ Muscles that oppose wrist extension may be weak when lateral epicondylitis has developed. Recommend strengthening exercises for wrist flexors to balance strength.

Description

Acute or chronic pain in the lumbar region stemming from (a) an increased resting muscle tension of the muscles of the lumbar region or (b) a strain of the muscles of the lumbar region and/or the ligaments of the lumbar spine.318-321 It may result from injury or postural imbalance.

Relevant Anatomy

Quadratus lumborum, erector spinae, thoracolumbar fascia, latissimus dorsi

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Abdominal, hip extensor and hip flexor muscle testing ■ Impaired muscle performance

■ Gait analysis ■ Gait dysfunction

■ Pain visual analog scale ■ Pain

■ Palpation ■ Muscle spasm ■ Impaired connective tissue mobility ■ Increased resting muscle tension

■ Postural examination ■ Postural malalignment

■ Thoracic and lumbar spine passive accessory joint ROM ■ Impaired joint mobility and joint integrity

■ Thoracic and lumbopelvic ROM ■ Impaired joint mobility

■ Functional examination ■ Limitations in work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Increased muscle performance: rhythmic mobilization, rocking, percussive techniques

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Increased connective tissue mobility; normalized joint integrity and posture: cross fiber and longitudinal strokes, petrissage, stripping, specific compression, direct fascial techniques, myofascial release, friction

■ Decreased resting muscle tension (primary and compensatory) and muscle spasm; normalized neuromuscular tone: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

Relevant Complementary Techniques

■ Hydrotherapy, body mechanics, and back care education

Contraindications and Precautions

■ A detailed health history may reveal herniated discs, a spaceoccupying lesion, or systemic conditions that require caution or may be contraindications to treatment.

■ Refer the client to his health-care provider if you suspect a nonmusculoskeletal cause.

■ Be cautious not to compress nerves or cause numbness and tingling.

Helpful Hints

■ Imbalances in abdominal and lower extremity muscle length and/or strength and lower extremity postural malalignment may contribute to low back pain.

■ Wearing high heels may increase the lumbar lordotic curve and contribute to low back pain.

■ Trigger points in rectus abdominis, lumbar multifidi, lumbar erector spinae, and gluteus medius may be contributory factors

Description

Acute or chronic pain (usually heel pain), thickening and/or inflammation of the plantar fascia, a band of connective tissue on the plantarsurface of the foot that lies between the calcaneus and the toes.318-321 It may be caused by overuse, a sudden increase in activity, or posturalimbalance.

Relevant Anatomy

Plantar fascia, flexor digitorum brevis, abductor hallucis

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Ankle and foot muscle extensibility testing ■ Impaired muscle extensibility

■ Gait analysis ■ Gait dysfunction

■ Pain visual analog scale ■ Pain

■ Palpation ■ Impaired connective tissue integrity ■ Pain

■ Postural examination ■ Postural malalignment

■ Functional examination ■ Limitations in weight-bearing work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Normalized connective tissue integrity; increased muscle extensibility: cross fiber and longitudinal strokes, petrissage, stripping, specific compression, direct fascial techniques, myofascial release, friction

■ Decreased resting muscle tension (primary and compensatory); normalized neuromuscular tone: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

Relevant Complementary Techniques

■ Hydrotherapy, stretching and strengthening exercises for calf and intrinsic foot muscles

Contraindications and Precautions

■ Be cautious when treating in the region of the vessels in the tarsal tunnel.

■ Avoid deep treatment of the leg of a client who is at risk for developing blood clots.

Helpful Hints

■ Trigger points in gastrocnemius, abductor hallucis, tibialis posterior, flexor digitorum longus, and soleus refer into the plantar surface of the foot.

Description

Pain in the gluteal region and posterior thigh resulting from compression or irritation of the sciatic nerve by a hypertonic piriformis muscle or trigger points in the piriformis muscle.318-321 It may be caused by overuse, postural imbalance, or injury.

Relevant Anatomy

Piriformis, greater sciatic notch, gluteus medius, gluteus minimus, sciatic nerve

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Gait analysis ■ Gait dysfunction

■ Hip range of motion measurement ■ Impaired joint mobility

■ Hip muscle extensibility testing ■ Impaired muscle extensibility

■ Hip muscle strength testing ■ Impaired muscle performance

■ Neurodynamic tension tests ■ Impaired neurodynamics

■ Pain visual analog scale ■ Pain

■ Palpation ■ Pain ■ Increased resting muscle tension

■ Trigger point examination ■ Trigger points

■ Functional examination ■ Limitations in weight-bearing work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

■ Increased muscle extensibility: cross fiber strokes, myofascial release, direct fascial technique, friction, petrissage, stripping, specific compression

■ Increased muscle performance: rhythmic mobilization, rocking, percussive techniques

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Decreased resting muscle tension (primary and compensatory):

effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

■ Deactivated trigger points: trigger point pressure release, cross fiber strokes, passive stretching

Relevant Complementary Techniques

■ Hydrotherapy, muscle energy techniques, stretching and strengthening exercises

Contraindications and Precautions

■ Take care not to compress the sciatic nerve with enough pressure or duration to reproduce symptoms

■ Be cautious of other causes of hip and leg pain including disc herniations and space-occupying lesions

Helpful Hints

■ The smaller lateral rotators of the hips are frequently hypertonic when the piriformis is hypertonic; address these as needed.

■ Trigger points in gluteus medius, gluteus minimus, and piriformis may contribute to symptoms.

Description

Pain, inflammation, and decreased range of motion of the glenohumeral joint resulting from a stretching or tearing of the muscles of therotator cuff.318-321 This may be the result of injury, postural imbalance, or overuse.

Relevant Anatomy

Supraspinatus, infraspinatus, teres minor, subscapularis

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Pain visual analog scale ■ Pain

■ Palpation ■ Pain ■ Increased resting muscle tension

■ Postural examination ■ Postural malalignment

■ Selective tissue tension testing ■ Impaired muscle integrity

■ Shoulder muscle strength testing ■ Impaired muscle performance

■ Shoulder passive accessory motion testing ■ Impaired joint mobility and joint integrity

■ Shoulder range of motion measurements ■ Impaired joint mobility

■ Functional examination ■ Limitations in overhead and behind the back work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Decreased resting muscle tension (primary and compensatory); normalized muscle tone: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

■ Normalized muscle and joint integrity; normalized posture: cross fiber and longitudinal strokes, petrissage, stripping, specific compression, direct fascial techniques, friction, myofascial release

■ Increased muscle performance: rhythmic mobilization, rocking, percussive techniques

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

Relevant Complementary Techniques

■ Hydrotherapy, therapeutic exercise, body mechanics education, muscle energy techniques

Contraindications and Precautions

■ Be cautious of vessels and nerves in the axilla.

■ Avoid placing the arm in painful ranges such as above 80° of shoulder flexion.

Helpful Hints

■ Trigger points in any muscle that crosses the glenohumeral joint may be contributory factors.

Description

Sudden onset of pain, decreased range of motion, and muscle tightness of the cervical spine.318-321 It can have multiple causes such as muscle strain, poor body mechanics or positioning, or psychosocial stress.

Relevant Anatomy

Levator scapulae, sternocleidomastoid

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Cervical spine passive accessory motion testing ■ Impaired joint mobility and joint integrity

■ Cervical spine range of motion measurement ■ Impaired joint mobility

■ Pain visual analog scale ■ Pain

■ Palpation ■ Pain■ Muscle spasm■ Increased resting muscle tension

■ Postural examination ■ Postural malalignment

■ Functional examination ■ Limitations in work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Normalized joint integrity and posture: cross fiber and longitudinal strokes, petrissage, stripping, specific compression, direct fascial techniques, friction, myofascial release

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Decreased resting muscle tension (primary and compensatory); spasm normalized neuromuscular tone: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

Relevant Complementary Techniques

■ Hydrotherapy, body mechanics education, neck stretching and strengthening exercises

Contraindications And Precautions

■ Be cautious near the vessels and nerves in the anterior and posterior triangles of the neck

■ Be cautious of other causes of neck pain including disc herniations and space-occupying lesions

■ If the client presents with fever, vomiting, or severe headache, refer to a physician for investigation of infection such as meningitis.

Helpful Hints

■ If the client presents with head forward posture, treat anterior tissues from inferior to superior, and lateral to medial.

Description

Chronic stress is a prolonged and heightened state of arousal that has negative physiological and psychological consequences. Chronicstress responses occur over the cognitive, physiological, affective, or behavioral domains and may have consequences such as impairedcognitive function, depression, anxiety, muscle tension, and impaired social functioning.

Depression is a mood disorder that is characterized by feelings of sadness, worthlessness, or hopelessness; disturbances in sleep and eating;and a variety of other symptoms.318-321 It may be classified as either a major depressive disorder or a mild depression (dysthymia).Anxiety is an increase in fear, worrying, or nervousness in response to a situation or event.318-321 This is different from anxiety disorders,such as panic disorders or post-traumatic stress disorder, in which individuals experience intense episodes of fearfulness and require medicalmanagement.

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Interview for perceived stress levels and symptoms and reports of depression or anxiety ■ Reported stress, depression, or anxiety

■ Pain diagram ■ Pain or tenderness

■ Palpation of area of reported symptoms ■ Increased resting muscle tension

■ Self-report stress measures ■ Reported increased stress

■ Trigger point examination ■ Trigger points

■ Functional examination ■ Possible limitations in work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Increased relaxation and decreased resting muscle tension: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

■ Increased arousal (for depressed mood): percussive techniques

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Deactivated trigger points: trigger point pressure release, cross fiber strokes, passive stretching

Relevant Complementary Techniques

■ Relaxed breathing, relaxing music, relaxation technique (meditation and progressive relaxation), gentle exercise

Contraindications and Precautions

■ Clients who present with a primary complaint of stress may have associated anxiety and depression; screen for these during the client interview.

■ Refer the patient for counseling if the patient is showing signs of distress or reports that stress, anxiety, or depression is a significant concern.

■ When client reports high levels of stress or anxiety, avoid techniques that stimulate the nervous system (e.g., percussive techniques, fast moving strokes, and ice).

■ Avoid excess pressure or deep stroking that may cause pain or stimulate the nervous system.

■ Refer the client to the physician if the patient has symptoms suggesting a chronic pain syndrome.

Helpful Hints

■ Ending the session with gentle massage to the head, face, or hands can be relaxing.

■ Scents, sounds, and light may stimulate the nervous system of a stressed, anxious, or depressed client.

■ Assess the client for tension headaches and the presence of trigger points in the neck and shoulder muscles since these may ooccur in people who complain of stress, anxiety, or depression.

Description

Episodic or chronic dull, aching headache that may be caused by muscle tension and trigger points.318-321 Temporal headaches may arise from the temporal muscles while suboccipital headaches may result from the suboccipital muscles.

Relevant Anatomy

Temporal: Frontalis, temporalis, occipitalis

Suboccipital: Suboccipital muscles, semispinalis capitis and cervicis, longissimus capitis, trapezius

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Cervical spine range of motion (for suboccipital headaches) ■ Impaired joint mobility

■ Pain visual analog scale ■ Pain

■ Palpation ■ Muscle spasm■ Increased resting muscle tension

■ Passive accessory motion of cervical spine (for suboccipital headaches) ■ Impaired joint mobility and joint integrity

■ Postural examination ■ Postural malalignment

■ Trigger point examination ■ Trigger points

■ Functional examination ■ Limitations in work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Decreased resting muscle tension (primary and compensatory) and muscle spasm; normalized neuromuscular tone: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

■ Normalized joint integrity and posture: cross fiber and longitudinal strokes, petrissage, stripping, specific compression, direct fascial techniques, friction, myofascial release

■ Deactivated trigger points: trigger point pressure release, cross fiber strokes, passive stretching

Relevant Complementary Techniques

■ Gentle pulling of the hair may help reduce tension in relevant anatomy. Asking the client to open/close the mouth and eyes while applying techniques may enhance treatment results.

■ Hydrotherapy, muscle energy techniques

Contraindications And Precautions

■ For sudden, acute episodes and long-term chronic cases of headaches, be certain to understand the client’s health history and any non-musculoskeletal factors that may contribute to headaches (e.g., neurological, infectious, and space-occupying lesion).

■ Be cautious of vessels and nerves in the anterior and posterior triangles of the neck.

■ Take care not to sustain techniques or pressure that may increase symptoms.

■ Take care not to stretch tissues that are hypotonic or overstretched.

■ Refer client to their health-care provider if you suspect a cause other than musculoskeletal.

Helpful Hints

■ Temporomandibular joint issues may contribute to temporal headaches.

■ There are a variety of trigger points that have referral patterns that mimic or contribute to headaches such as trapezius, splenii, temporalis, masseter, sternocleidomastoid, and suboccipitals.

■ Scents, sounds, and light may disturb a client with an active headache.

Description

Compression of the nerves and/or blood vessels that pass through the thoracic outlet resulting in gradual onset of pain, numbness and tingling, or edema in the neck, arm, and hand.318-321 Progression of TOS may lead to decreased strength and tone of the involved muscles. The causes include anatomical abnormalities, postural imbalance, injury, or overuse.

Relevant Anatomy

Scalenes, first rib, subclavian artery, brachial plexus, clavicle

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Pain diagram ■ Pain ■ Paresthesia

■ Pain visual analog scale ■ Pain

■ Palpation ■ Increased resting muscle tension

■ Postural examination ■ Postural malalignment

■ Respiratory pattern examination (chest vs. diaphragmatic) ■ Abnormal respiratory pattern

■ Special tests for TOS ■ Confirmation of TOS

■ Trigger point examination ■ Trigger points

■ Upper extremity muscle strength testing ■ Impaired muscle performance

■ Upper extremity neurodynamic tension tests ■ Impaired neurodynamics

■ Functional examination ■ Limitations in work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Decreased resting muscle tension (primary and compensatory); normalized neuromuscular tone: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

■ Normalized posture: myofascial release, direct fascial technique

■ Increased rib cage mobility: broad-contact compression, petrissage

■ Deactivated trigger points: trigger point pressure release, cross fiber strokes, passive stretching

■ Increased muscle performance: rhythmic mobilization, rocking, percussive techniques

Relevant Complementary Techniques

■ Hydrotherapy, muscle energy techniques, relaxation techniques, diaphragmatic breathing, therapeutic exercise

Contraindications and Precautions

■ Be cautious near the vessels and nerves in the anterior and posterior triangles of the neck.

■ Be cautious not to stretch tissues that are already lengthened.

■ Refer client to health-care provider if you suspect a cause other than musculoskeletal.

Helpful Hints

■ Protraction of the shoulder girdles leading to internal rotation of glenohumeral joint often accompanies TOS. As time permits, lengthen the medial rotators of the arm.

■ The head forward posture frequently accompanies TOS. In forward head posture the deep anterior muscles (e.g., longus colli) are lengthened and weak and the posterior muscles are short. As time permits, lengthen the muscles of the posterior neck.

■ Trigger points in pectoralis minor, scalenes, and subclavius may contribute to or mimic symptoms of TOS.

Description

Dr. Janda defined upper crossed syndrome as a muscle imbalance in which there is increase tone of the upper trapezius, levator, sterno cleidomastoid, and pectoralis muscles, accompanied by decreased tone of the deep cervical flexors, lower trapezius, and serratus anterior.This muscle imbalance and associated weakness results in pain and postural imbalance.

Relevant Anatomy

Levator scapulae, trapezius, rhomboids, pectoralis major, pectoralis minor, sternocleidomastoid, serratus anterior

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

■ Cervical and thoracic spine passive accessory motion testing ■ Impaired joint mobility and joint integrity

■ Cervical and thoracic spine range of motion measurement ■ Impaired joint mobility

■ Pain visual analog scale ■ Pain

■ Palpation ■ Pain■ Increased resting muscle tension

■ Postural examination ■ Postural malalignment

■ Trigger point examination ■ Trigger points

■ Functional examination ■ Limitations in work, recreational, and self-care activities

Relevant Outcomes and Massage Techniques

■ Normalized joint integrity and posture: cross fiber and longitudinal strokes, petrissage, stripping, specific compression, direct fascial techniques, friction, myofascial release

■ Increased joint mobility: direct fascial techniques, friction, myofascial release, rhythmic mobilization, rocking

■ Decreased pain: superficial effleurage, myofascial release, direct fascial technique, shaking, rhythmic mobilization

■ Decreased resting muscle tension (primary muscles with increased tone and compensatory muscles: effleurage, petrissage, stripping, specific compression, myofascial release, direct fascial technique, rhythmic mobilization, rocking, shaking

■ Deactivated trigger points: trigger point pressure release, cross fiber strokes, passive stretching

■ Normalized neuromuscular tone and performance (muscles with decreased tone): compression, deep effleurage, petrissage, and percussive techniques

Relevant Complementary Techniques

■ Hydrotherapy, muscle energy techniques, neck and upper back stretching and strengthening exercises, body mechanics education

Contraindications and Precautions

■ Be cautious near the vessels and nerves in the anterior and posterior triangles of the neck.

■ Be cautious not to stretch tissues that are already lengthened.

■ Be cautious of other causes of neck pain including disc herniations and space-occupying lesions.

Helpful Hints

■ In forward head posture the deep anterior muscles (e.g., longus colli) are lengthened and weak and the posterior muscles are short. As time permits, lengthen the muscles of the posterior neck.

Description

Injury of the muscles, ligaments, joints, and nerve roots of the cervical region following a rapid or extreme neck flexion and/or extension.This can result in a variety of symptoms such as pain, decreased range of motion of the cervical spine, muscle tightness, and paresthesia.

Relevant Anatomy

Sternocleidomastoid, trapezius, splenius capitis and cervicis, suboccipital muscles, semispinalis capitis and cervicis, longissimus capitis, levator scapulae

Relevant Examination Techniques, Impairments, and Activity Limitations

Examination Techniques Impairments in Body Structure or Function

Relevant Outcomes and Massage Techniques

Relevant Complementary Techniques

Contraindications and Precautions

Helpful Hints