Treatments really are the meat and potatoes of massage for me.  This is the class where you learn some techniques to really get at a person’s problems.  Sure Swedish massage is important as it is the basis of all other forms of massage, but Swedish massage in and of itself will not solve a lot of the pain problems that people have.  Sure Swedish massage to the low back will feel good for someone with low back pain, but it won’t change the cause of his or her pain.  A properly laid out treatment plan can do that, depending on what the cause of the pain is.

On Friday, we began postural assessments.  This is a lengthy process, but one that can be very invaluable.  The main focus of our class on Friday was assessing static posture with a plumb line and grid board, as well as assessing gait (someone’s walking pattern).

As you can assume, this is a very introductory look at postural analysis and much more time is needed to become proficient at it.  However, even the untrained (or barely trained) eye can still pick up some very important observations.

When a posture and gait assessment are combined with active range of motion, passive range of motion, and resisted range of motion, the picture of the cause of a person’s pain becomes much more clear.  Using these tools, it is easier to figure out if the pain is caused by scar tissue formation, connective tissue adhesions, or other factors.  Again, I am just scratching the surface of the knowledge that is out there.  Just remember that a good massage therapist is capable of much more than you may think.  Heck, that is probably why it is a profession that is predicted to grow faster than average over the next few years.

Another important consideration that you must make, is that a massage therapist cannot diagnose your pain, that is left for someone with a medical license.  However, just because I can’t diagnose your problem, doesn’t mean I can’t work on it.

We are now inching our way down to the long muscles of the thumb – abductor pollicis longus, extensor pollicis brevis, extensor pollicis longus, and flexor pollicis longus.

Abductor Pollicis Longus

Origin

• Posterior surface of the middle of the radius, ulna, and interosseous membrane

Insertion

• Base of the first metacarpal bone on the radial side

Action

• Abduction of the thumb
• Abduction of the wrist (radial deviation)
• Extension of the thumb
• Extension of the wrist

Nerve Supply

• Radial Nerve

So there you have it. The Abductor Pollicis Longus muscle.

I have completed the first 6 lessons and the fact that this is a FREE resource still amazes me.  This site provides an exorbitant amount of excellent information.  So far I have learned about the following topics:

• Deciding on a Business

This was not that helpful for me, as I already know that I want to open a massage therapy practice.  However, there was still some useful information.

• The Business Plan

The need for a business plan is so important.  Don’t open a business without one.  This section explains why and how to complete a business plan.  In fact, the other sections of the website take you through step by step in completing the business plan.

• Computer and Communication Tools

You have to have a phone, computer and an Internet connection.  It’s not an option anymore.  But what factors do you need to consider?  That’s where this section comes in.

• Organization

Should you have a partner?  Should you be a corporation, sole proprietorship, or partnership?  What laws do you need to take into consideration?  Don’t forget about the IRS.  This section helps you decide these important parts of your business.

• Business Licenses and Permits

Every business needs certain licenses and permits.  This section helps you figure out where to find the requirements for your business.

• Insurance

You don’t want to lose everything in a fire, so you better get insurance.  But what else do you need covered by insurance and how do you get it?  That’s where this section comes in.

As you can tell, just from the brief amount of information above, there is a lot that goes into starting a business and making it successful.  If you, like me, have no formal education in business, but are looking to start your own, then this website is a great starting point.  Take advantage of the fact that it is FREE.

Origin

• Flexor retinaculum
• Trapezium carpal bone
• Trapezoid carpal bone
• Capitate carpal bone

Insertion

• Base of proximal phalange of the thumb
• Note that this is where the abductor pollicis brevis and adductor pollicis attach as well.

Action

• Flexion of the thumb
• Assists in opposition

Nerve Supply

• Median nerve
• Note that the median nerve also innervates the opponens pollicis and abductor pollicis brevis, but the ulnar nerve innervates the adductor pollicis.

Other Information

• This muscle is part of the thenar eminence
• This muscle crosses the metacarpophalangeal joint (MCP), but not the interphalangeal joint (IP), therefore it only acts on the MCP joint.
• Weakness in this muscle will negatively affect the ability to grip objects.

In this post, I will just discuss the treatments class, as this is really my area of interest.  I find Shiatsu to be an interesting subject, however, I just don’t understand it enough to discuss it in any great detail.

So what have we been doing in treatments?

Connective Tissue Work

Some of you might be familiar with Thomas Myers, who wrote Anatomy Trains.  In that book, he discusses at length how the fascial system works in the human body.  Basically, it is the tissue that wraps around (connects) all the other tissues in the body and thus has a profound impact on posture and muscle function.  Through manipulation of the connective tissue, massage therapists can improve a clients posture and also their muscle function.  We spent just a few days learning various connective tissue techniques that accomplish such postural changes.  Certainly, this is an area in which I will pursue continuing education.

Massage & Medications

We have also spent some time on how medications affect massage.  Certainly, as a massage therapist you are not expected to know what every drug on the market does, that’s a pharmacist’s job.  However, it is important to know how to find out that information because medications can affect the outcomes of a massage and massage can affect how a medication works in the body.  Interesting stuff, I assure you.

Trigger Point Therapy

Another 2 days was spent on trigger points.  Many of you are aware that I read and thoroughly enjoyed Clair Davies’ Trigger Point Therapy Workbook.  For anyone interested in trigger points, that book is an excellent starting point.  In class, we learned techniques for dealing with trigger points, however finding specific trigger points and their referral pain patterns were not discussed.  I do believe that trigger points are a significant cause of pain, therefore, I will also pursue continued education in this topic.  More specifically, I plan to read Travell & Simmons works on trigger points.

Muscle Energy Techniques

For those of you who are strength and conditioning professionals, muscle energy techniques are nothing more than proprioceptive neuromuscular facilitation stretches (PNF).  If you have taken the CSCS or NSCA-CPT exams, this information will not be new to you.  Since, we just started this information in class, I will wait until next week to give more background information as well as my thoughts.

How to read these posts:

Some of you may wonder, what is the point to these posts.  Most importantly, I want everyone to realize that getting a license in massage is not as easy as just showing up to class.  There is a lot of information to learn.  However, most of the information is only briefly covered, so continuing education is required.

For those of you who are professionals, whether in fitness, medicine, or what have you, I want you to get an understanding of what is involved in the education of a massage therapist.  Massage is very powerful and can help a lot of people, but only if you know what a particular therapist can do and what a specific client needs.

In addition, I want to make educated consumers of those of you who either currently receive massage or are thinking about it for the first time.  Even though most therapists learn the same information in school, there are the opportunities for continuing education in specific areas, which differentiates therapists.

I do hope that everyone gets something out of this blog.  Please leave your feedback on what improvements can be made.

As someone who has studies exercise science, nutrition, and is currently studying massage therapy, I am aware that water is an important topic of conversation.  In fact, I am surprised that I haven’t written anything on it up to this point.

Water is necessary for the transport of nutrients, wastes, hormones, enzymes, and blood cells throughout the body.  It also acts as a lubricant for joints, the digestive and urinary tracts, organs, and saliva.  It is an important structural unit of compounds in our body as well as a substance that has great ability to absorb heat.

The total amount of water in the body varies based on several factors.  It varies due to age, generally speaking, younger individuals have a higher percentage of body weight as water than do older adults.  It also varies based on muscle mass, with those who are more muscular having more water weight.  Muscle is 70-75% water, whereas adipose tissue is 10-40% water.

The total body water of an individual is divided among two main compartments, the extracellular fluid and the intracellular fluid.  The extracellular fluid can be further divided into the interstitial fluid that bathes all cells, plasma, and transcellular fluid that is formed from cellular transport activities.

Water balance results when water losses are equal to water intake.  Water can be lost through several methods including urine, feces, respiration, and evaporation.  Insensible water loss occurs through evaporation and respiration and varies based on such factors as environmental temperature, humidity, altitude, clothing, blood circulation and water content of the body.  Water is gained through two primary methods: metabolic production and consumption through foods and beverages.  Both of these vary widely.

This brings us to the meat and potatoes of this post: Water Intake Recommendations.  The following recommendations come from the North American Branch of the International Life Sciences Institute.

• Infants 0-6 months: 0.7 L/day
• Infants 7-12 months: 0.8 L/day
• Children 1-3 years: 1.3 L/day
• Children 4-8 years: 1.4 L/day
• Adult Men 19-30 years: 3.7 L/day
• Adult Women 19-30 years: 2.7 L/day

These recommendations are just that, recommendations.  They are based on the average person, however the specific amount that any one individual will need to consume will vary based on the factors listed previously.  Anything that causes an increase in the amount of water lost from the body will result in a need to increase intake.

I hope this post got you to start thinking about the amount of water you drink on a daily basis.  Chances are it isn’t enough.

Think about these facts, which were handed out in class the other day and comes from the New York State Society of Medical Massage Therapists:

• 75% of Americans are chronically dehydrated
• In 37% of Americans, the thirst mechanism is so weak that it is often mistaken for hunger.
• Even mild dehydration will slow down one’s metabolism as much as 3%
• Lack of water is the #1 trigger of daytime fatigue
• Preliminary research indicates that 8-10 glasses of water a day could significantly ease back and joint pain for up to 80% of sufferers
• A mere 2% drop in body water can trigger fuzzy short-term memory, trouble with basic math, and difficulty focusing on the computer screen or a printed page.

In this weeks post on muscles, we continue yet again with the short muscles of the thumb.  This time with the Abductor Pollicis Brevis.

Origin

• Flexor retinaculum
• Trapezium tubercle
• Scaphoid tubercle

Insertion

• Base of proximal phalange of the thumb on the radial side

Action

• Abduction of the carpometacarpal and metacarpophalangeal joints of the thumb
• Assists in opposition of the thumb

Nerve

• Median nerve

Other Information

• All 3 muscles of the thenar eminence (opponens pollicis, abductor pollicis brevis, and flexor pollicis brevis) are innervated by the median nerve.

I know I posted about an exercise yesterday, but I want to talk a little about one of my absolute favorite exercises.

The Single Leg Romanian Deadlift (SL-RDL)

I really like this exercise because it works balance, gluteus muscle strength, core strength, scapular stability, among other things.  If you have ever tried this exercise, then you know just how difficult it is.  It’s not something that I would throw at a beginner.  The persons form in the picture above is actually very good.  You will notice several things that make her form excellent:

• shoulder blades retracted
• hips in a neutral position with respect to the ground, not opened or closed.  In other words, one hip is not higher than the other.
• back leg is straight
• neck is also in a neutral position, not hyperextended or flexed
• assuming this is the end position of her repetition, her position is excellent because she ends the rep while her torso is parallel to the ground.  All too often you will see an athlete either stop short of this position or keep going so that they are below parallel, which brings me to my next point…
• neutral curve in low back, not hyperextended or flexed.  Flexion occurs when an athlete tries to have too much range of motion as explained in the previous bullet, or because they lack the proprioceptive ability to know their low back positioning.

Progressions:

• as above, with no weight
• add weight in the form of dumbbells or a barbell
• you can also add more of a rotational component by having a dumbbell in one hand and not the other

So, there you have it.  Another exercise that is fantastic to add into your programming, but only if done right.  As I always tell the athletes and clients I train, if you can’t do it right, you probably shouldn’t be doing it.  That and let’s find a way so that you can do it right.

This month’s “Exercise of the Month” is the Pallof Press.

First, let’s talk a little about the abdominal muscles.

There are 4 abdominal muscles: the rectus abdominus, internal and external obliques, and the transverse abdominus.  Let’s take a look at the actions of each muscle:

Rectus Abdominus:

• flexes the vertebral column and compresses the abdominal contents

External Obliques:

• unilateral (when one side contracts and the other does not): contralateral (opposite side) rotation and lateral flexion of the vertebral column
• bilateral (when both sides contract): flexes the vertebral column and compresses the abdominal contents

Internal Obliques:

• unilateral: ipsilateral (same side) rotation of the vertebral column and lateral flexion of the vertebral column
• bilateral: flexion of the vertebral column and compression of the abdominal contents

Transverse Abdominus

• compression of the abdominal contents and increases intra-abdominal pressure

Traditional abdominal training involves an infinite amount of situps and crunches, which work primarily the rectus abdominus.   I want to show you one exercise that works all 4 abdominal muscles in their main role of stabilizing the spine.  Enter the pallof press.

Here are some tips on how to correctly execute the pallof press:

Setup:

• Stand perpendicular to the weight stack on a cable stack or functional trainer with the arm at chest level.
• While completing the exercise, assume an athletic position with knees slightly bent, butt back, chest up, and feet slightly wider than shoulder width apart.

Performance:

• Begin with the handle at your sternum.  I prefer to use an interlocking grip, but you can use other grips as well.
• Press the handle out, using full range of motion, until your elbows lock out.  Making sure the whole time to resist any rotation of your body.  In other words, your body position should be exactly the same in the start position as in the end position with the exception being that your arms are extended.
• After achieving full lockout of your elbows and pausing for a second, unlock and return the handle to your chest (again resisting rotation).
• Complete all the reps, usually 10, on one side and then complete them on the other.

Continuing on with the short muscles of the thumb, today I will discuss the Adductor Pollicis.  It is important to remember that this muscle acts like one of the interossei muscles, as you will learn later on.

Origin

• Capitate (a carpal bone)
• 2^nd Metacarpal
• 3^rd Metacarpal

Insertion

• Base of the proximal phalange of the thumb.  (Remember that there are just two phalanges in the thumb and that the proximal one is the one closest to the wrist.  In addition, the base of any phalange is the most proximal portion.)

Action

• Adduction of the thumb
• Flexion of the thumb

Nerve Supply

• Ulnar Nerve