I swing into action asking the standard intake questions that are on my intake form first to rule out the obvious issues first. Like what medications are you currently taking and are you already under a doctor’s care. I switched gears and started to assess the shoulder to see if I can tell where the issue may be. Which shoulder is it that the pain is in? Right or left, the patient kindly remarks that it’s in my right shoulder. I immediately ask almost by instant knee jerk reaction, “Are you right handed?”

A light turns on and I remember that I could refer back to my shoulder pain assessment worksheet/form in the sport massage book on page 50, but before I did that I first asked the patient, “Is there any particular movement of the right arm that you can do that causes a sharp or dull pain?” Normally, the problems that we face in life are ones that are staring us in the face.  The answer surprised me because he came back saying, “No, not particularly”.

So I started going through the motions to see if I could figure out through assessment what was going on. So the patient actively raised his arm above his head without any issues. Asked the patient to actively abduct the arm no issues found. Asked the patient to actively adduct the arm he didn’t complain of any issues the first time he did this movement.

I switched to passive movements of the arm and felt that when moving the arm no feeling of anything grating or hindering the movement of the arm. I did passive elevation and noticed that when I did the movement, that a little soreness was found when I moved the arm above the head. Not because of what he said, but because I was watching his face and it told me more than what the patient was verbally telling me. I still checked for passive abduction, lateral rotation, mediation rotation and finally horizontal rotation all presented as sore but no lack in range of motion and the end points all felt natural.

 Moving down the list of possible issues, I switched again to resisted abduction and adduction of the arm. I noticed that abduction was quite forceful when he did the movement and I resisted his arm. Then I did a resisted adduction of the arm and pain along with weakness was found. Moving down the list I also went a step further and did the resistive lateral rotation and found that the force was much like it was when I did the abduction test.

So, I noted things and continued on trying not to let the patient know what I suspected could be wrong. Resisted medial rotation and elbow flexion lead to no issues, and finally the same results when resisted elbow extension was done. So I asked the patient to stand up straight in front of a postural chart to see if he was favoring a bad posture. Did notice that he favored his right side when he shifted his weight but no other abnormalities where found.

I suspect that he had issues in the pectorals, Latissimus dorsi, and teres minor and teres major.  So doing a little more investigation I started to palpate the suspect muscle(s) groups. I found that the pectoralis major and minor where tight and thread like. The Teres major and minor where the same. So I told the patient I could spend some time treating the soft tissue but it the pain lingers after the massage that I would like to refer him back to his primary physician with some information. I would write up SOAP notes and fax them to this doctor. He wanted me to do some stretching, effleurage, petrissage on the muscle to see if we could work out some of the thread like features of the muscles so to stimulate the healing process. I also told him that no matter what I could not solve this issue in a single 1 hour session. Muscle fibers take time to heal and added that I may have to do cross fiber friction to break up and lesions that I find so that the soft tissues could heal properly.

Where still working on his treatment, I hope to see him back a couple more times but after the first treatment I saw improvement on the range of motion and comfort level when he was actively moving his arm through the plains of motion that I asked him to test.

The autonomic nervous system is then broken down into the sympathetic and parasympathetic nervous system. The sensory nerves and their associated receptors provide input to the central nervous system on sensation and proprioception, in other words their location in space and surrounding environmental conditions. The sympathetic and parasympathetic nervous system is primarily those that are affected by massage. During a relaxation massage the sympathetic is calmed while the parasympathetic is stimulated since the two are opposite in relation to one another. Information from the sensory input is processed in the central nervous system, the appropriate responses are sent out via the motor neurons and various other pathways such as the somatic and  autonomic in order to maintain that equilibrium called homeostasis.

The nervous system can be stimulated or soothed based on the strokes that are applied to the body. Stimulation applied to the peripheral nerve receptors can have a reflex reaction affecting the neurotransmitters in the brain, the pain perception, or joints and muscles that are being massaged.

Stimulating massage strokes:

• Friction
• Percussion
• Vibration

Sedative massage strokes:

• effleurage
• light friction and petrissage
• holding pressure (compression)

The amount of blood supply to the muscle is proportional to the amount of activity done by the body in every day life, exercise and in the face of danger.  The latest estimate is that three (3) times more blood passes through muscles that are massaged on a regular basis than those at perpetual rest.  Petrissage or kneading the muscles along with compression movements forces venous flow to increase and lymph flow forcing the body to replace the fluids that are push out of the muscle tissue. In turn, supplying fresh new oxygenated blood to the muscles. Massage also aids the metabolic waste removal in the lymph system.

Massage will relieve stiff and soreness of muscles by work or exercise compared to the same muscles that are at passive rest for the same amount of time.  Muscle tissues that have suffered injury heals much more quickly with less connective tissue build up and scarring when therapeutic massage is applied on a regular basis. Massage can release fascial constrictions and reduce the thickening of connective tissues, which in turn allows for more flexibility in muscles. Friction when applied properly prevents and reduces the development of adhesion’s and excessive scarring following trauma to the tissues.

Massage Range of motion on the limbs that have limited amounts of range due to injury, inflammation, muscle tension or strain can experience greater mobility when applied by the therapist. The patient may experience levels of pain or discomfort during the treatment but experience more flexibility and range of motion once the treatment has ended. Passive massage movements will benefit circulation nourishment of the skin, relaxation and lengthening of muscles, soothe the nerves, and lubricate the joints.

The German method uses many of the Swedish movements yet combines these basic movements with highlighting the use of various different types of baths. The French and English systems use many of the Swedish massage techniques for the entire body.

Acupressure comes from the Chinese medical practice of acupuncture and comes from Traditional Chinese Medicine principles. Chinese use these principles in assessing and treating the physical and energetic body. Acupressure uses various different methods to apply pressure in many of the same points that acupuncture uses to bring Chi (Universal life energy) back into balance. The aim of Chinese medicine is to be preventative in nature to relieve pain, discomfort, or other physiological dirorders.

The Japanses system called Shiatsu, uses finger pressure methods on similar points of Traditional Chinese Medicine only these points are called Tsubo points. When pressure is properly applied to these points, circulation of blood and nerves are stimulated. This system of massage is said to improve the bodies metabolism and relieves a number of physical disorders.

Sports massage refers to a method of massage especially designed to prepare an athlete for competition or an event and then restore body function after the event. This is done by specialized manipulations of soft tissue that will stimulate the blood and lymph system. Some movements are designed to breakdown adhesions and lesions to reduce fatigue. Sports massage generally uses Swedish strokes with various movements that when applied will benefit the athlete and achieve the necessary results. Professional sports teams often employ specialized trained therapists for various sports such as baseball, football, basketball, hockey, ice skating, and swimming.

Active Movements were done by the patient and were known as exercise. Passive movements were performed by a therapist to the patient and would later be called Range of Motion. Duplicated movements were when the client or patient was doing the same movement as the therapist in cooperation. Today Duplicated has been broken down into two additional categories they are resistive and assistive exercises.

The Ling system better known today as Swedish Movements spread very quickly throughout Europe and Russia. Most of the institutions that taught the movements where located in Germany. The program was as long as three years in length and classes where generally six to eight hours a day.

Later the Taylor Brothers would learn Swedish movements in Europe and bring them back to the United States. The Taylor Brothers would later teach the movements and brought massage into the public and medical community. Acceptance would come later as personal boundaries shifted.

The modern terminology that we use today was formalized by Dr. Johann Mezger of Holland. Dr Mezger would establish remedial treatments for the practice of massage. He was acknowledged by many as the author and founder of scientific massage.  Dr. Mezger preferred the french terminology for massage which has remained an influence to this day. The words effleurage, petrissage, and tapotement all originated from french words that describe the movements.

Effluerage – effluerage is a succession of stokes applied by gliding the hand over an extended portion of the body. Effluerage is used primary for warming up, palpation, and applying lubricant to the surface of the skin.

Petrissage - Petrissage lifts, squeezes, and presses the tissues. Petrissage is used to milk the body or belly of the mucsle and to lengthen the muscle of contracted sarcomeres that have not released.

Tapotement – Tapotement movements include tapping, slapping, hacking, cupping and beating. Tapotement is used to stimulate the body or liven up the patient on the table. It is in limited fashion stimulating.