Although trigger points may be treated directly with any of the above techniques, resolution of them requires passive stretching of the muscle as soon after treatment as possible. The therapist stretches the muscle by moving its attachments away from each other (Fig. 1-25). This technique requires an intimate knowledge of the anatomy of the joints involved and their range of motion.
Approach stretching with care. Familiarize yourself with the range of motion of each joint, and move into the stretch slowly. It is very easy to place a client in an uncomfortable position (Fig. 1-26).
Most of the manual therapy descriptions in this book are of stripping massage and compression, with a few examples of cross-fiber friction and stretching where such techniques seem particularly appropriate. These descriptions should be
P.26 taken as examples and starting points, not as an exhaustive repertoire. Each student should experiment with them, as well as with other possibilities not illustrated.
Figure 1-25 Passive stretching
Figure 1-26 Unfortunate passive stretching
Tables
Students of massage therapy will certainly be familiar with standard massage tables. The most popular tables are
portable and can be adjusted in height between clients. Therapists generally set the table height according to their own height and the type of work they plan to do. Clinical massage therapy, however, makes special demands. The optimum table height may vary according to the type of work being done and the position of the client. You may use several different treatment approaches in a session, and place the client in several different positions. To accommodate this flexibility in treatment, the ideal solution is an adjustable electric table. A wide variety of such tables is available, either mechanical or pneumatic: prices vary widely as well. These tables are considerably more expensive than a standard portable table, but the investment is well worthwhile, since it enhances both the quality of the work that can be done and the comfort and health of the therapist.
In addition, many therapists find an arched table to be a helpful addition to the treatment room. Such tables include the BodyBridgeâ„¢ (Fig. 1-27A) and the Khalsa Bodywork Tableâ„¢ (Fig. 1-27B).
Draping
Most examination and treatment in massage therapy and bodywork require some exposure of the body. Therefore, we need to consider ways of respecting the client's feelings of privacy and modesty, while still accomplishing the therapeutic goal. Draping is the term commonly used for the covering of the parts of the client's body that are not being examined or treated. The term originated in the art world, where it referred to the drapery of the subject of a painting or sculpture. In the last century it came to be used in photography as well, and from that field was adopted by the medical profession.
The codes of ethics and standards of practice of various organizations vary somewhat, but all require consideration of the client's feelings of privacy and modesty. The National Certification Board for Therapeutic Massage and Bodywork states in its Code of Ethics that the certificant shall “provide draping and treatment in a way that ensures the safety, comfort, and privacy of the client,― and in its Standards of Practice that the certificant shall “use appropriate draping to protect the client's physical and emotional privacy.― Although these requirements are unequivocal about the need to consider the client's sense of privacy and modesty, they are not specific in describing precisely what draping is to be used. Therapists, therefore, have the responsibility to determine the best ways to meet these requirements in their own clinical settings with regard to each individual client.
In addition to requirements of professional organizations, therapists must also consider the laws of the jurisdictions in which they practice.
P.27 In states where massage therapy is licensed, a board normally issues guidelines for the conduct of practitioners.
These guidelines often contain more or less specific provisions regarding draping of clients. Some guidelines, for example, specifically permit the uncovering of buttocks or female breasts with the consent of the client, whereas others may specifically prohibit such exposure. In states that do not have licensure, laws may exist either at the state or local level that restrict the practitioner's conduct in some way. Therapists must, therefore, take the responsibility for investigating the laws and guidelines that govern their practices.
Figure 1-27 Arched tables: BodyBridge (A) and Khalsa Bodywork Table (B)
Early in the chapter we saw that clinical massage therapy is the result of the coalescence of traditional massage, osteopathic and other techniques, and the bodywork heritage of Wilhelm
P.28 Reich and Ida Rolf. In traditional massage, the client normally lies prone or supine on a table, with private areas of the body covered by a towel or sheet. Each area is uncovered by the therapist as necessary for treatment. In the bodywork tradition, the emphasis is on the structure of the body as a whole. For that reason, clients are first observed while standing, usually in underwear. Most schools of massage therapy teach conservative, traditional draping techniques, and require that these techniques be used when practicing massage therapy in the school setting. As therapists move beyond basic Swedish massage, however, they are likely to need more flexibility in methods of draping to perform the variety of techniques for examination and treatment available to them.
Therefore, depending on the approach, the therapist, the client, and applicable regulations, the client may wear
underwear or not, be covered by a sheet or towel, wear an examination gown, or any combination of these choices.
With the understanding that both therapists and clients vary widely in their needs, we will present a variety of illustrations of suggested draping for the examination and treatment of each area of the body. Throughout the chapters on treatment, our technique for illustrating internal structures dictates that adult models be shown with only minimal draping and child models in underwear, but we will refer back to the appropriate draping illustrations for the benefit of the student.
We show the basic techniques of draping clients with sheets in supine and prone positions. In conjunction with the technique for draping female breasts for abdominal massage, we show a way of arranging the drape for treating the chest muscles. We also show techniques for draping clients in a sidelying position. This position is well suited for performing certain techniques. It is also appropriate for the general treatment of pregnant women, and we provide illustrations for that specific situation.
Some therapists may find it helpful to use an examination gown in some situations, either instead of or in addition to a sheet, towel, or underwear. The most versatile such gown for massage therapy unfastens across each shoulder.
The use of these gowns is illustrated as an option for treatment of some areas.
1: Head and neck
2: Abdomen
3: Chest muscles
4: Anterior leg
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5: Groin and lower abdomen (A and B, sheet; C, examination gown)
6: Turning the client
7: Back
8: Between buttocks
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9: Positioning the sheet under the leg
10: Posterior leg and buttock
11: Sidelying: shoulder and back (pregnant client)
12: Sidelying: thigh (pregnant client)
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13: Sidelying: buttock (pregnant client)
14: Sidelying: lower leg (pregnant client)
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15: Sidelying: shoulder and chest (examination gown)
16: Sitting: shoulder and chest (examination gown)
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