What Massage Therapy Can Really Do:
Beyond Relaxation

Wounds – Burns

CI:

• Don’t drag on the tissue

Positioning:

• Pillow underneath the limb

Contusion

CI:

• Don’t drag on the tissue
• No distal techniques in acute stage

Positioning:

• Pillow underneath the limb or put it in underneath their abdomen if their back is hurt

Strains and Sprains

Goals:

• Reduce Edema, H+, adhesions, Increase ROM and circulation

CI:

• No distal circulation techniques in acute
•  

Positioning:

• Pillow underneath the limb or under their abdomen if their back is hurt

Dislocations

Goals:

• Reduce Edema, H+, adhesions, Increase ROM and circulation

CI:

• No distal circulation techniques in acute
• Don’t put their joint in the same position with which it was dislocated (For shoulder, they usually dislocate anteriorly in lat rot + abd, and posteriorly when in add, med rot and flexion)

Positioning:

• Pillow underneath the limb or under their abdomen if their back is hurt

Fractures

Goals:

• During immobilization, reduce pain, edema, only do proximal stuff

CI:

• No distal circulation techniques in acute
• No tractioning until union
• Careful of overpressure

Positioning:

• Pillow underneath the limb or under their abdomen if their back is hurt

Whiplash

Goals:

• Reduce Edema, H+ and TrP in neck and shoulder muscles, adhesions, Increase ROM and circulation
• Treat Infrahyoids, Suprahyoids, all the damn neck muscles

CI:

• Don’t massage both SCM at once
• Careful of mobilization of C4-C6
• Joint play shouldn’t be painful for the spine
• Careful of carotid artery

Positioning:

• Usually Supine for this

 Plantar Fascitis

Goals:

• Reduce Edema, H+, adhesions, Increase ROM and circulation
• Treat the posterior leg and potentially the thigh, glutes and lower back
• In chronic, gastrocs and soleus get tightened

CI:

• Don’t friction if they took anti-inflamms

Positioning:

• Prone first to do the compensating structures

Periostitis and Compartment Syndrome

Goals:

• Reduce Edema, H+, adhesions, Increase ROM and circulation
• Treat compensating structures, like the low back, gluteal and thighs, then treat shortened gastrocs and soleus

CI:

• No distal circulation techniques in acute
• No frictions if anti-inflamms

Positioning:

• Put them in prone to do compensating structures (low back, thighs and gluteals)

Tendinitis

Goals:

• Reduce Edema, H+, adhesions, Increase ROM and circulation

CI:

• No Frictions if taking inflamms

Positioning:

• Pillow underneath the limb or under their abdomen if their back is hurt

Bursitis

Goals:

• Reduce Edema, H+, adhesions, Increase ROM and circulation

CI:

• No on-site techniques
• Avoid compressing bursa and don’t drag the surrounding tissue

Positioning:

• Pillow underneath the limb if bursitis is there and for comfort so it’s not compressed

Frozen Shoulder

Goals:

• Reduce Edema, H+, adhesions, Increase ROM and circulation
• Work the entire shoulder girdle
• TrP in subscap
• They’re most restricted in LAM – Lat rot, abd, then med rot. – so working medial rotators like subscap help because that’s the muscle restricting the lat rot.

CI:

• No aggressive stretching or joint play
• Frictions again – if inflamm, don’t do it dude

Positioning:

• Pillow with spinal roll if they have hyperkyphosis – probably should do supine first

Torticollis

Goals:

• Decrease pain, spasm and abnormal positioning
• Ask them to do some DDB
• You have to do PNF for this – esp for SCM
• Be Gentle!

CI:

• Avoid full stretches to SCM
• For Acute acquired torticollis – don’t passively stretch spasmodic muscles
• For Spasmodic torticollis – don’t do any painful techniques, joint play or local direct massage

Positioning:

• Supine with pillows on unaffected side supporting the pillows under the head

Tension Headache

Goals:

• Get rid of their headache
• Work on head and neck muscles including traps, splenii, occiput, occipitalis

CI:

• Don’t be aggressive

Positioning:

• Pillow with spinal roll if they have hyperkyphosis – probably should do supine first

Migraine

Goals:

• In attacks it’s a relaxation massage
• In-Between attacks you try to reduce SNS firing, H+, TrPs and joint issues

CI:

• Don’t be aggressive

Positioning:

• Pillow for comfort

Pes Planus

Goals:

• Treat compensating structures like low back, glutes and thighs
• Fascial on gastrocs
• TrP in peroneals

CI:

• Don’t mobilize the joints on the medial longitudinal arches
• Don’t stretch tib ant or tib post.
• Frictions – inflamm

Positioning:

• Pillow them in prone, put one underneath the abdomen

Iliotibial band contracture

Goals:

• Reduce contractured fascia, H+ and TrP

CI:

• Do not randomly stretch fascia – assess then treat restrictions
• Frictions – inflamm

Positioning:

• Pillow them sidelying – 3 pillows

Patellafemoral syndrome

Goals:

• Reduce contractured fascia, H+ and TrP (tfl, glute med, hamstring and gastric) and hamstring

CI:

• Don’t force them into flexion of knee
• Careful of inflammation

Positioning:

• Pillow them however

Hyperlordosis

Goals:

• Reduce fascial restrictions – iliopsoas, and hip flexors
• TrP and H+ work – still in hip flexors (TFL, rec. fem.)

CI:

• Don’t hypermobilize vertebral segments
• Don’t randomly stretch fascia
• Careful of femoral artery and aorta
• Don’t lengthen overstretched tissues

Positioning:

• Pillow supine, under knees

Hyperkyphosis

Goals:

• An anterior pelvic tilt – hip flexors are shortened
• A posterior pelvic tilt – hamstrings are shortened
• Reduce fascial restrictions, H+ TrPs

CI:

• Don’t hypermobilize vertebral segments
• Don’t randomly stretch fascia
• Careful of femoral artery and aorta
• Don’t lengthen overstretched tissues

Positioning:

• Pillow supine, under knees

Scoliosis

Goals:

• Multifidi, erector spinae and intercostal muscles on concave side become shorter, tighter and fibrosed
• Reduce lordotic curve through reducing H+, fascial restrictions, stretching

CI:

• Don’t hypermobilize vertebral segments
• Careful of previous rib injuries – don’t rib spring
• No longitudinal work on he convex side since they’re already stretched
• Careful of metal rods
• Don’t randomly stretch fascia

Positioning:

• Pillow however (I would do prone)

Temporalmandibular Joint dysfunction

Goals:

• Posterior portion of temporalis can pull the condyle posteriorly in relation to disc
• Anterior disc displacement – condyle is on thicker posterior portion of disc instead of its normal thinner middle portion
• Closer to full opening the pop occurs, the more anterior the displacement of disc
• Work neck and jaw – fascial, H+, TrPs

CI:

• Careful of arteries, don’t massabe both SCM
• Careful of styloid process – fragile
• Frictions – inflamm
• Don’t compress the mandible against the TMJ

Positioning:

• Pillow supine (IMO)

Degenerative Disc Disease

Goals:

• Reduce compressive forces on disc and nerves – start with ant. Thorax for DDD cerv
• Do hip flexors if they have DDD with hyperlordosis
• Do hamstrings if they have flatback/posterior pelvic tilt

CI:

• Don’t mobilize hypermobile joint
• Don’t remove protective spasming
• Careful of areas of muscle atrophy

Positioning:

• Pillow however – probably supine for cerv, and prone for lumbar

Disc Herniation

Goals:

• Reduce compressive forces on disc and nerves
• Reduce spasm and pain and edema

CI:

• Don’t mobilize hypermobile joint
• Don’t remove protective spasming
• Careful of areas of muscle atrophy

Positioning:

• For posterolateral protrusion – no pillow under knees or abdomen – in cervical use a small towel roll under neck
• For anterior protrusion – keep lumbar flexed with pillows under knees and abdomen, and use pillow for cervical spine

Osteoarthritis

Goals:

• Reduce stiffness, pain and edema and spasm

CI:

• No heat – inflamm
• Careful with osteophyte formation

Positioning:

• Pillow however

Seizures

Goals:

• Looks like it’s relaxation

CI:

• Avoid deep, vigorous or painful techniques

Positioning:

• Pillow however

Hemiplegia

Goals:

• Reduce edema, limit contractures, address postural changes
• Reduce spasticity
• PROM to promote awareness on paralyzed side

CI:

• Be very light on the SCM
• Only work one side of the neck at a time
• Modify pressure

Positioning:

• Pillow however the client wishes to be

Multiple Sclerosis

Goals:

• Reduce edema, limit contractures, address postural changes
• Reduce spasticity
• PROM to promote awareness on paralyzed side

CI:

• Avoid painful techniques like frictions
• Don’t use deep tech over altered sensation

Positioning:

• Pillow however the client wishes to be

Parkinsons

Goals:

• Reduce edema, limit contractures, address postural changes
• Work on intercostals, thoracic and diaphragm

CI:

• Avoid painful techniques
• Careful of hypo/hypertension

Positioning:

• Pillow however – depending on degree of rigidity and severity of forward flexion of thorax
• In prone, use a length-wise pillow and towels underneath the shoulder
• In supine pillow their head to support the forward flexion of the trunk

Cerebal Palsy

Goals:

• Reduce edema, limit contractures, address postural changes
• Reduce spasticity
• PROM to promote awareness on paralyzed side
• Working respiration muscles

CI:

• Careful of joint tech and ribspringing – they may have osteoporosis
• No vigorous techniques

Positioning:

• Pillow however the client wishes to be

Spinal Cord Injury

Goals:

• Reduce edema, limit contractures, address postural changes
• Reduce spasticity
• PROM to promote awareness on paralyzed side
• Work respiration muscles

CI:

• Depending on severity, you can only do side-lying if diaphragm compromised
• No vigorous tech
• No joint play or aggressive tech if OA or OP

Positioning:

• Pillow however the client wishes to be (unless diaphragm issues)

Poliomyelitis

Goals:

• Reduce edema, limit contractures, address postural changes
• Reduce spasticity
• PROM to promote awareness on paralyzed side – usually tib ant, post., peroneals, quads and glute med.

CI:

• Avoid vigorous techniques

Positioning:

• Pillow however the client wishes to be

Radial nerve lesion

Goals:

• They’ll have wrist drop – wrist extensors are flaccid, so contracture can develop on wrist flexors
• The area that is paralyzed is the posterior portion of the hand, forearm and arm
• Decrease SNS firing, Edema at proximal site, decrease H+ and TrPs of unaffected proximal muscles
• Light stroking to denervated tissue
• PROM to promote awareness to paralyzed side

CI:

• Don’t work the lesion site until neurologist says so
• Don’t traction or move joints of affected limb
• No frictions or vigorous techniques on flaccid tissue
• No joint play until innervation and stable joint
• No Rhythmic techniques until reinnervation

Positioning:

• Prone and sidelying work better for upper limb lesion – don’t let their arm hang over edge of table (affected one) in the late stages
• Supine works better for the early stages of a regenerating nerve

Ulnar nerve lesion

Goals:

• They’ll have claw hand, hyperextension of fingers due to loss of finger flexors (work on finger extensors)
• Hypothenar eminence will have muscle wasting
• Decrease SNS firing, Edema at proximal site, decrease H+ and TrPs of unaffected proximal muscles
• Light stroking to denervated tissue
• PROM to promote awareness to paralyzed side

CI:

• Don’t work the lesion site until neurologist says so
• Don’t traction or move joints of affected limb
• No frictions or vigorous techniques on flaccid tissue
• No joint play until innervation and stable joint
• No Rhythmic techniques until reinnervation

Positioning:

• Prone and sidelying work better for upper limb lesion – don’t let their arm hang over edge of table (affected one) in the late stages
• Supine works better for the early stages of a regenerating nerve

Median Nerve Lesion

Goals:

• You’ll have ape hand or benedict’s sign since the thenar flexors and opponens policis, as well as flexors of index and middle finger won’t work
• Will lose the first 3 fingers and lateral ½ of fourth, plus the entire palmar side, and just the finger side of the dorsal
• Decrease SNS firing, Edema at proximal site, decrease H+ and TrPs of unaffected proximal muscles
• Light stroking to denervated tissue
• PROM to promote awareness to paralyzed side

CI:

• Don’t work the lesion site until neurologist says so
• Don’t traction or move joints of affected limb
• No frictions or vigorous techniques on flaccid tissue
• No joint play until innervation and stable joint
• No Rhythmic techniques until reinnervation

Positioning:

• Prone and sidelying work better for upper limb lesion – don’t let their arm hang over edge of table (affected one) in the late stages
• Supine works better for the early stages of a regenerating nerve

Sciatic nerve lesions

Goals:

• They’ll have foot drop, paralysis of dorsiflexors and evertors of the foot – so it hangs in plantar flexion and inversion
• Can result in claw toe – hyperextension of MCP joints
• Can waste muscles in hamstrings and posterior leg (tibial)
• Muscle wasting in anterior leg (common peroneal)
• Decrease SNS firing, Edema at proximal site, decrease H+ and TrPs of unaffected proximal muscles
• Light stroking to denervated tissue
• PROM to promote awareness to paralyzed side

CI:

• Don’t work the lesion site until neurologist says so
• Don’t traction or move joints of affected limb
• No frictions or vigorous techniques on flaccid tissue
• No joint play until innervation and stable joint
• No Rhythmic techniques until reinnervation

Positioning:

• Prone and sidelying work better for upper limb lesion – don’t let their arm hang over edge of table (affected one) in the late stages
• Supine works better for the early stages of a regenerating nerve

Bell’s Palsy

Goals:

• They’ll have paralysis of the facial nerve, usually unilaterally with flaccid types of paralysis
• Decrease SNS Firing
• Reduce Edema, prevent contracture, decrease pain maintain tissue health
• Work anterior chest, neck, then unaffected fascial muscles TOWARDS LESION SITE
• Encourage motor re-education – maintain awareness of paralyzed tissue – PROM

CI:

• Modify pressure for flaccid tissue
• Don’t use long dragging strokes are fascial techniques on affected side

Positioning:

• Pillow however the client wishes to be

Thoracic Outlet Syndrome

Goals:

• Treat the entire shoulder girdle and neck
• Decrease compression, reduce fascial restrictions
• Reduce pain, H+, TrPs

CI:

• Careful if they have other conditions

Positioning:

• Pillow however the client wishes to be

Carpal Tunnel Syndrome

Goals:

• Reduce edema, fascial restrictions, H+, TrP
• Decrease compression on median nerve, reduce fascial restrictions
• Reduce pain, H+, TrPs
• Treat muscles innervated by median nerve
  • Pronator teres, flexor carpi radialis, brachioradialis, palmaris longus, flexodr digitorum superficialis
• Many TrPs in neck refer down arm

CI:

• Careful if they have other conditions

Positioning:

• Pillow however the client wishes to be

Piriformis Syndrome

Goals:

• Treat compensating structures – low back and hip
• Treat Piriformis
• Decrease compression on Sciatic Nerve

CI:

• Careful if they have other conditions
• Don’t compress the Sciaic nerve

Positioning:

• Prone probably.

Sinusitis

Goals:

• Work anything connected to ribs basically
• Do Paranasals
• Anterior chest and neck

CI:

• If they have a fever, don’t touch ‘em
• No Lymphatic drainage if they’re acute, well, obvs, because they’re sick.

Positioning:

• Pillow however the client wishes to be
• Prone can irritate their sinuses, but good for draining

Chronic Bronchitis

Goals:

• Reduce Fascial restrictions
• Reduce H+, TrP
• Mobilize thorax
• Drain lobes
  • Lower Lobe – Pillow under abdomen, and slap near T7 (Prone)
  • Right Middle Lobe – Pillow under right thorax and knees, then slap that (Supine)
  • Upper Lobe – have them sit up and slap em at the top, just below C7
• Use tapotement slowly, and make sure not to bronchospasm them, then end with gentle techniques

CI:

• Don’t use too painful techniques
• Careful of Joint play if rib issues
• Don’t tapotement over bony prominences, floating ribs and boobies

Positioning:

• Pillow however the client wishes to be

Emphysema

Goals:

• Relax accessory muscles of respiration
• Encourage Diaphragmatic breathing
• May have postural dysfunction (hyperkyphosis)

CI:

• Don’t use too painful techniques
• Avoid Supine and Prone if they have severe Emphysema
• Don’t use joint play on them if they have bad ribs
• Careful if they have hypertension (usually people with chronic airflow obstruction will)

Positioning:

• Pillow semi-supine (Prop them up) or sidelying

Asthma

Goals:

• Mobilize Thorax, Work on Anterior Chest and Neck
• Reduce fascial restrictions
• Reduce H+, TrPs,
• Treat Diaphragm

CI:

• Careful of Asthma Triggers
• Don’t use too painful techniques
• Careful of xiphoid process and ribs if they have rib issues
• Careful of hypertension since chronic air flow obstruction cause it

Positioning:

• Pillow however the client wishes to be
• Prone usually works better
• If in supine, Pillow them up more in case of hypertension

Raynaud’s Phenomenon

Goals:

• Reduce fascial restrictions
• Use soothing techniques

CI:

• No Cold Hydro
• Careful of painful techniques
• Careful of Deep techniques on bad tissue

Positioning:

• Pillow however the client wishes to be

Varicose Veins

Goals:

• Work with making them more relaxed!!!

CI:

• Be careful of local massage, esp if painful
• DVT symptoms!?

Positioning:

• Pillow however the client wishes to be but always elevate legs and shin

Constipation

Goals:

• Reduce stress
• Focus on lumbar, sacrum and glutes
• Erector Spinae, QL, lateral rotators
• Abdomen, head, neck and shoulders
• Decrease congestion in abdomen and increase circulation to there
• Iliopsoas work
• Move fecal matter

CI:

• Diarrhea means gtfo

Positioning:

• Pillow under abdomen and ankles in prone
• Pillow under knees to maintain hip in 90 degrees of flexion

Irritable Bowel Syndrome 

Goals:

• Reduce stress
• Focus on lumbar, sacrum and glutes
• Erector Spinae, QL, lateral rotators
• Abdomen, head, neck and shoulders
• Decrease congestion in abdomen and increase circulation to there
• Iliopsoas work
• Move fecal matter

CI:

• Diarrhea means gtfo (if you have IBS, you’ll have both a constipation and diarrhea phase, so treat IBS with a constipation tx as long as they’re in that phase and not in the diarrhea phase)

Positioning:

• Pillow under abdomen and ankles in prone
• Pillow under knees to maintain hip in 90 degrees of flexion

Ankylosing Spondylitis

Goals:

• They will have no lordotic curve in lumbar, will have hyperkyphosis and head forward posture
• Decrease pain, hypertonicity, trigger points, thoracolumbar mobility and respiratory function
• Treat like a hyperkyphosis tx, focus on anterior thorax and neck

CI:

• Diarrhea means gtfo

Positioning:

• Pillow supine probably, and pillow well

Gout

Goals:

• Reduce stress
• Decrease pain, edema and spasm
• Maintain joint mobility, strength
• Prevent/reduce postural changes
• Reduce contractures
• Gentle PROM

CI:

• Only do AROM if acute inflammation
• Careful of lymph drainage if acute infection proximally
• No local massage over inflamed areas
• Don’t use too painful tech
• DON’T DO JOINT PLAY ON CERVICAL NECK FOR RHEUMATOID ARTHRITIS
• Careful of lax joints – don’t do joint play

Positioning:

• Pillow however client wishes to be

Infectious Arthritis

Goals:

• Reduce stress
• Decrease pain, edema and spasm
• Maintain joint mobility, strength
• Prevent/reduce postural changes
• Reduce contractures
• Gentle PROM

CI:

• Only do AROM if acute inflammation
• Careful of lymph drainage if acute infection proximally
• No local massage over inflamed areas
• Don’t use too painful tech
• DON’T DO JOINT PLAY ON CERVICAL NECK FOR RHEUMATOID ARTHRITIS
• Careful of lax joints – don’t do joint play

Positioning:

• Pillow however the patient wishes to be

Lyme Disease

Goals:

• Reduce stress
• Decrease pain, edema and spasm
• Maintain joint mobility, strength
• Prevent/reduce postural changes
• Reduce contractures

CI:

• Only do AROM if acute inflammation
• Careful of lymph drainage if acute infection proximally
• No local massage over inflamed areas
• Don’t use too painful tech
• DON’T DO JOINT PLAY ON CERVICAL NECK FOR RHEUMATOID ARTHRITIS
• Careful of lax joints – don’t do joint play

Positioning:

• Pillow however client wishes to be

Reiter’s syndrome

Goals:

• Reduce stress
• Decrease pain, edema and spasm
• Maintain joint mobility, strength
• Prevent/reduce postural changes
• Reduce contractures
• Gentle PROM

CI:

• Only do AROM if acute inflammation
• Careful of lymph drainage if acute infection proximally
• No local massage over inflamed areas
• Don’t use too painful tech
• DON’T DO JOINT PLAY ON CERVICAL NECK FOR RHEUMATOID ARTHRITIS
• Careful of lax joints – don’t do joint play

Positioning:

• Pillow however client wishes to be

Rheumatoid Arthritis

Goals:

• Reduce stress
• Decrease pain, edema and spasm
• Maintain joint mobility, strength
• Prevent/reduce postural changes
• Reduce contractures
• Gentle PROM

CI:

• Only do AROM if acute inflammation
• Careful of lymph drainage if acute infection proximally
• No local massage over inflamed areas
• Don’t use too painful tech
• DON’T DO JOINT PLAY ON CERVICAL NECK FOR RHEUMATOID ARTHRITIS
• Careful of lax joints – don’t do joint play

Positioning:

• Pillow however client wishes to be

Scleroderma

Goals:

• Fascial restrictions on posterior trunk, moving towards affected extremities
• Reduce stress
• Decrease pain, edema and spasm
• Maintain joint mobility, strength
• Prevent/reduce postural changes
• Reduce contractures

CI:

• Only do AROM if acute inflammation
• Careful of lymph drainage if acute infection proximally
• No local massage over inflamed areas
• Don’t use too painful tech
• DON’T DO JOINT PLAY ON CERVICAL NECK FOR RHEUMATOID ARTHRITIS
• Careful of lax joints – don’t do joint play

Positioning:

• Pillow however client wishes to be

Systemic Lupus Erythematosus

Goals:

• Reduce stress
• Decrease pain, edema and spasm
• Maintain joint mobility, strength
• Prevent/reduce postural changes
• Reduce contractures

CI:

• Only do AROM if acute inflammation
• Careful of lymph drainage if acute infection proximally
• No local massage over inflamed areas
• Don’t use too painful tech
• DON’T DO JOINT PLAY ON CERVICAL NECK FOR RHEUMATOID ARTHRITIS
• Careful of lax joints – don’t do joint play

Positioning:

• Pillow however client wishes to be