Assessment Task 1 – Assessment Task:

Assessment Task 1 – Assessment Task:

1) Where are the following Endangerment sites located – please mark them on the diagram on the following page:

1. anterior triangle of the neck: ○5
2. posterior triangle of the neck: ○4
3. femoral triangle: ○8
4. cubital fossa: ○1
5. axillary area: ○24
6. medial epicondyle:○20
7. lateral epicondyle: ○21
8. sternal notch and anterior throat: ○5
9. umbilicus: ○18
10. twelfth rib dorsal body:○23
11. sciatic notch: ○14
12. inguinal triangle: ○22
13. popliteal fossa ○12

Explain: What are the Sites of Endangerment and how do you use palpatory skills in these areas according to the scope of practice for a Remedial Therapist (min of 100 words)

Endangerment sites are body areas that constitute superficial delicate structures that are susceptible to injuries due to being relatively unprotected. Endangerment sites are not protected by body structures and due to their location on the outside of the body makes them be endangered.

Endangered structures include nerves, joint capsules, organs, bony projections, and glands. Also, endangerment sites include as follows popliteal fossa, an anterior and posterior triangle of the neck, inguinal triangle, axillary area, sciatic notch, sternal notch, and anterior throat, medial and lateral epicondyle, and twelfth rib posterior body.

Also, endangerment site areas are likely to be damaged by massage treatment if the therapist does not understand the location of those areas or the type of structures during palpation. Therefore, to avoid causing risks on the endangered parts of the body during massage treatment the therapist is required to observe and locate the sites before performing palpation on the client as well as understand the anatomical body structure to easy identification of the potential sites that are endangered. In cases where the client feels discomfort with the palpation, the process should be stopped and the application of direct pressure on endangered sites avoided.

In remedial massage treatment, palpation assessment entails evaluation of the health state of muscles of individuals and soft tissues through touch. Palpation helps the therapist to identify tight and loose muscles, locked trigger points, injured muscles, and the amount of pressure that needs to apply to various muscles during treatment. Palpation assessment can be done by following the steps below:

1) Know the origin or specific location of the muscles being palpated to avoid missing out any muscle parts.

2) Understand the muscles specific actions.

3) Add resistance to movements to enhance the easier palpation of the muscles.

During a remedial massage treatment, palpatory skills are important when working at the anterior of the neck. Anterior of the neck contains most endangerment sites such as a carotid artery, thyroid glands, nerves brachial plexus, and trachea. Palpation of anterior of the neck entails identifying, locating, and palpating the muscles within this region. The sternocleidomastoid is palpated by first letting the client seat and the therapist stand behind and to the side being palpated. The client usually rotates the neck and head to the opposite side and laterally flex neck and head on the same side as the therapist applies resistance.

3) Describe the characteristics of the potential reactions during treatment as listed below and explain how to respond according to your scope of practice as a remedial massage therapist? (min 100 words for each)

• Discomfort

During or after a massage treatment, the client can feel discomfort as a result of pain associated with the treatment. It is, therefore, the duty of massage therapist to often confirm with the client whether during the treatment he or she is experiencing any form of discomfort to allow adjustment of the technique used or provide enough warm-up that prepares tense superficial muscles. When applying deep pressure massage, the therapist should observe the client’s body reaction and voice tone to identify any form of discomfort. Also, when applying massage treatment, the therapist should communicate with the client to ascertain if they experience any form of pain or soreness that is outside their range of comfort. Massage treatment has the capability of increasing the flow of blood in the muscles, removing toxins and providing nutrients, which can result in temporary inflammation as the body heals. As the body heals the client might experience discomfort due to delayed onset muscle soreness, which is a physical response to the inflammation.

The client should be educated properly regarding the impact of massage treatment such as feeling soreness and pain after deep tissue massage. However, the pains associated with deep tissue massage usually go away after one to two days. The client should be made aware that the breaking of muscle fibers during a massage promotes healing that improves their health body and also should be advised to drink plenty of water to flush toxins accumulated in muscles and have enough rest to assist in recovery.

• Emotional reactions

During a massage treatment, there is a high possibility that the remedial massage therapist will see their client express emotional reactions that were suppressed deep in their minds. It is a result of the activation of parasympathetic nerves when the massage causes muscle relaxation. Also, massage causes certain stimuli from the peripheral nervous system that makes body memory refer to past events that in turn triggers emotions. The client experiences emotions being freed as the physical tension of the body of the client is reduced and softened during a remedial massage. However, the client can experience conflicting emotions or does not become aware of what is happening at present during massage. Therefore, during the massage, the client can react by getting angry, cry, or laugh and it occurs when they are unconscious. In the process of emotional reaction, the client might request the therapist to stop the treatment and allow him or her to calm down. Thus, a suitable environment should be provided for the client to respond peacefully to their emotions. However, if the emotions persist in client they should be referred to a specialist for support.

• Feedback – verbal, tactile, visual

During the process of remedial massage treatment, the remedial therapist and clients communicate in diverse ways that include visual, tactile, and verbal. The use of more feedback skills in the massage process allows the therapist to accurately understand the status of the client. Verbal feedback can include asking the client questions like ”how is the pressure am using?” to get their feedback and accommodate their preferences and needs. Tactile feedback involves the therapist applying a sense of touch to get feedback from their client under massage while visual feedback occurs during the whole process of massage treatment and kinesthetic communication that occur in the client’s body.

In incidences where the client and therapist experience language barriers, the massage therapist applies body charts and screening tools where the client indicates the place or part of the body they are experiencing pain. During a massage treatment, the therapist is required to keep an eye on non-verbal communications to help provide the best massage and meet the needs of the clients, and where possible if the client experiences discomfort the client should provide feedback on how they are feeling. In massage treatment, the therapist needs to pay attention to the muscle textures, voice tone, and body movement of clients. Receiving constant feedback from clients ensures the provision of treatment that is in their comfort zones.

• Muscle Spasm

Muscle spasms can likely occur during the massage due to the client being uncomfortable and tense or the massage therapist is exerting too much pressure as well as pinches the nerves or cuts off the circulation of blood in muscles. As a remedial massage therapist once I notice the occurrence of muscle spasm I will take the responsibility of releasing the pressure from the area being massaged and ask the client if any other external conditions are causing the problem such as dehydration or stress.

Muscle spasms result when muscles are involuntarily and forcibly contracted to the extent that they cannot relax and its occurrence is more subtle and shallower compared to a muscle cramp. Its visible signs include twitching. Also, muscle spasms results due to dehydration, abnormal levels of minerals, and overuse of nerves as well as cutting off the supply of blood, and trigger points that disable muscles from normal functioning.

In the process of alleviating muscle spasms, remedial massage therapists tell their clients to stop all that triggers spasm, perform gentle stretching, and massage spasmodic muscles. Tender muscles should be applied cold and stretched gently until the spasm stops while tight muscles heated up to relieve the spasm. As a massage therapist, I will also advise the client to stay hydrated, eat a balanced diet, and stay within my scope of practice as well as refer the client for any advanced treatment for spasm if necessary.

• Body temperature discomfort

During a remedial massage treatment, there is a likelihood of the client experiencing cold or hot and the remedial massage therapist can assess the state of the client by either observing or asking questions to get feedback regarding how they feel. Temperature discomfort is characterized by the heat that results in fever and coldness, breathing difficulties, chills, shivering, and hypothermia. However, fever can also be a result of the body reacting to infections, medicines, injuries that is severe, and other medical conditions. Usually, during a massage, the blood flow improves, and the immunity of the body increases, which starts to actively react and fight against infections within the body thereby increasing body temperature. Also, massaging tight muscles results in the breaking of muscle fibers that cause inflammation on the body and as a result leads to the client feeling discomfort. Therefore, where the client feels discomfort due to too much heat than normal then the therapist should adjust the treatment or stop the massage process if necessary. The client can experience cold when the parasympathetic nerves become dormant during a relaxed state of the body. To activate the nerves the therapist is required to increase the pressure or speed of massage.

• Deep relaxation

Deep relaxation by massage relaxes stiff muscles, relieves body soreness, and activates parasympathetic nerves. Also, deep relaxation causes the client to experience slow breathing and sleepiness. However, if during the massage process the client falls asleep the therapist should speed up the massage process or apply more pressure that awakes the client from sleep. The therapist is only able to receive the client’s consent when he or she is awake. Also, another way of keeping the client awake during massage is to constantly ask questions or receive feedback regarding the pressure of the massage, changes in the level of pain, and engaging in conversation. Applying the massage treatment while the client is asleep risks their muscles from getting damaged due to excessive pressure.

4) What are some potential reactions experienced by your client post-treatment, and what appropriate advice and recommendations would you provide? (Site at least three types of reactions/responses and include types of advice and resources that the client can use outside of the clinical environment in your post-treatment recommendation.

After a client has undergone massage treatment he or she may experience muscle pain, fatigue, headaches, and sleepiness as a result of therapists working on their deep muscles to relieve tension that in turn breaks muscle fibers. In cases where during treatment by massage the muscle fibers are broken the client feels aching and muscle dullness. However, the reaction is considered normal and the body heals itself after which pain goes away within a day or two. Also, to keep the client aware of the impact associated with massage, the therapist explains to the client in advance about possibilities of reactions before beginning the massage treatment.

Therefore, after the client has received massage treatment they should be advised to take enough hydration, avoid intense exercises, perform light stretching, and have enough rest to help the body in recovering faster. Since deep pressure massage affects muscles when individuals drink plenty of water it assists in draining off the accumulated wastes while performing light stretching helps in keeping and extending a joint range of motions. The dilation of blood vessels during massage treatment can result in headaches and the client is advised to take short time showers to avoid increased blood flow that would promote headaches.

If a headache persists after the client reaches home he or she should ice the affected area to constrict the blood vessels that minimize blood flow. Also, the client should take foods that are rich in magnesium and drink lavender tea that assist the relaxation of the body and relieve headache. After the massage, the client should not drink alcohol as it will increase the flow of blood and induce headaches. Remedial massage treatment is known to activate the parasympathetic nerves, which makes the individual feel relaxed and desire to sleep. Feeling sleepy is considered a sign of the body responding to massage treatment and the relaxing muscles help in physical and mental relaxation.

5) Describe each remedial massage technique as listed below, include: i) how is the technique applied ii) when and why is the technique applied iii) what are the benefits of this technique

• Friction techniques

Friction is a technique of massage that increases circulation and releases tight areas such as joints, muscles, and tendons that have adhesions. The friction technique is used for the treatment of muscle strains, scar healing, tendinopathy, and ligament lesions. Friction massage influences the behaviour of the cell in all soft tissues and induces traumatic hyperemia that assists in the evacuation of pain triggering metabolites, collagen fibre realignment, and stimulation of mechanoreceptors. During deep friction, massage diagnostic palpation and movements should single out fault tissues and its exact location, and to avoid injuries to the skin fingers of the therapists should move simultaneously with the skin of the patient. The remedial massage therapist must deeply administer massage and within pain tolerance of the patients. The message must be given with sufficient sweep to assure that the whole scar is treated. The contraindications of friction massage include bacterial action causing inflammation, bursitis, and skin diseases.

• Compressive techniques

It is used on larger areas of muscles where pressure is applied onto the muscles, hold, and released. It is performed by laying hands over affected muscles and pushing them down onto tissues, after which hands are lifted and moved to diverse areas repeatedly. Apply deep and light pressures together with slight rocking movements that promote relaxation and stimulate the parasympathetic nervous system. Compression assists the body to relax, relieve tight muscles, and alleviates acute pain. Applying light pressure across the soft tissues increases circulation and temperature. Also, increasing temperature lengthen and softens muscles. Compression is used to treat calf, lower, and upper back.

• Passive joint movement techniques / Joint mobilization techniques

Passive joint movement is a technique that is often used to reduce pain, facilitate an individual return to normal activities after an injury, and improve the movement of joints. The technique stretches and moves the joints, and it is done by combining appropriate exercises. Passive stretching massage is depicted to lengthen the fascia and increase the circulation of blood through it, which increases the range of motion and declines pain or discomfort.

• Passive soft tissue movement

Soft tissue movement entails direct physical action on the muscles and soft body tissues. The technique aims at ligaments, muscles, fascia, and muscles. Passive soft tissue movement entails a whole massage depth range, durations, and pressure. It assists in alleviating pain, aches, and injuries of soft tissues of the body. Passive soft tissue movement is important because of the following benefits: it helps in muscle relaxation, increases the flow of lymph and blood, reduces joint inflammations, and relieves muscle tension as well as increasing ROM and flexibility of joints.

• Deep tissue massage

Deep tissue massage combines advanced massage techniques and Swedish massage used mainly in sports by remedial massage therapists. In this massage, patients are usually aware and with know-how regarding their fitness, health, and the importance of maintaining wellness. The remedial massage therapist is required to have in-depth knowledge about the body physiology and anatomy as well as common areas that are prone to injuries to allow for better provision of deep tissue massage treatment. Warmups that have light and fast strokes should precede deep tissue massage to avoid causing spasm and microtrauma. Deep tissue massage is essential as it assists in relaxing muscles that are tired and overworked, balances the nervous system, increases the flow of blood, and increases muscular and joints flexibility. The contraindication of deep tissue massage includes fractured bones, soft tissue inflammation, skin infection, unknown pain, and redness.

• Muscle energy techniques

It is a wider range of manual technique, which targets at improving joint function, pain, and relieving muscular spasm. The technique is done whereby the patient activates some group of muscles in a certain direction against précised resistance given by the remedial massage therapist. The activation of muscular reflex encourages ROM to return to its normal. The technique is important such that it assists in strengthening weaker muscles, improving ROM of joints, stretching the fascia and tight muscles, and relieving muscle spasm. During the treatment, the therapist resists the desired muscles while the client contracts it and pushes against the therapist. The contraction is held for five seconds, and the process repeated many times with a short rest between the intervals. MET helps in maintaining the flexibility of the muscles and the prevention of injury.

• Myofascial techniques

It is known that every muscle is normally surrounded by fascia, which is a fibrous sheath that helps in providing support, elimination or metabolism, and lymphatic fluid flow. When facia is entrapped, it results in ischemia that causes misalignment and pain. The myofascial technique is achieved by stretching technique that involves cross-hand release sequence, which is done by palpating restricted area, stretching the tissues until resistance is achieved, followed by holding the tension until the tissues which are under the hand feel to relax and soft. Stretching tissues take up slacks that were created by release, then hold. The process is then repeated until there is no further stretching of tissues. During the process, the therapist should avoid gliding hands. The contraindication of this technique includes sutures, fever, arthritis, skin sensitivity, and chronic diabetes.