Posts tagged ‘clinical’

Looking for persons to be involved as clinical massage case studies or to receive occasional sessions (Exeter, UK only!)



I have just come back from Brighton after spending a couple of days up there at The Jing Institute of Advanced Massage Training attending the introductory module that marked the commencement of the 2nd part of a BTEC Level 6 professional diploma programme in sports and clinical massage ( http://www.jingmassage.com/Level6BTEC.asp ).  This is a post graduate qualification for already qualified massage therapist (i.e. those who have qualified to at least ITEC Level 3 standard).  The 1st part of the diploma which I completed at the end of last year consisted mainly of practical and hands-on technique modules for common musculoskeletal pain pathologies such as lower back lower, shoulder, neck, headaches (as just a few examples) which spanned a 12 month period, whilst this 2nd part of the programme will span 18 months and look further into orthopaedic assessment tests, injury and rehab exercises.  During the next 18 months I am required to give 200 hours worth of treatments, which equates to about 3 sessions (on 3 different people) every week between now and October 2012 (each treatment would therefore be a 1 hour session for each person each time).  If you are interested, I would love to hear from you, you could come in just for a one off taster, the occasional session as and when your schedule permits or a series of sessions, whatever suits you so long as you give enough notice for me to schedule in advance.  First come, first served!

In addition to the 200 hours of on-going sessions as described above which will only require an initial in-take consultation and then a signature from each recipient for each session received thereafter, I am also required to produce 6 case studies.  Each case study requires me to see the same person over a series of 4 consecutive sessions and so being case studies I’d also be required to conduct an initial consultation as well as a brief de-brief after each session which will go towards the write-up submission for each case study.  The case studies are required to be spread throughout the 18 month duration, so rather than than have all the case studies done all at once right now, I would be looking for just a single person to be a case study to be fitted within roughly 2 – 3 month blocks at a time.  As each case study will be treated 4 times on an on-going weekly basis, it is important to note that if you would like to be a case study that you can commitment to a series of 4 weekly treatment (i.e. for 1 whole month) during a particular time period that can be agreed between us.  Bearing in mind that I will be spreading these 6 case studies out between now and October 2012, if at any time between now and then you yourself or anyone you know that would suitable as a case study please do get in contact.

For both the case studies as well as occasional session recipients the main requirement in common to both is that you have some kind of muscle related or musculoskeletal pain condition that you would be wiling to receive clinical massage sessions for and provide honest feedback on.

I am very happy to answer any questions that you may have or give more detailed information about what’s involved before you commit yourself either by return email, phone or Skype.

Please pass on the information contained herein to anyone you think would be interested, provided that they live within commuting distance of Exeter (UK) of course.

Many thanks and best wishes,
Henry Tang.

Email: info@isca-therapies.co.uk
Tel: 07970 020204
Skype: henryctang
www.isca-therapies.co.uk

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1 May, 2011 at 17:45 Leave a comment

Important muscles involved in hand, wrist & arm pain – Part 1

There are many intricate muscles and soft tissue structures in the hand, wrist and arm which can cause various types of pain, numbness sensations, weakness, pins and needles or electric shock type of sensations when they become constricted, tight or dehydrated through physical over use or misuse, bad posture, accidents, old injuries (such as high velocity neck impact or whiplash) and deep scar tissue, and/or combined with unremitting emotional stress.

2 muscles which I’d like to draw the reader’s particular special attention to in this article are the scalenes and pectroalis minor muscles.  These are 2 very important and relevant muscles which massage therapists who have been through advanced trainings in say for example clinical massage techniques will know how to treat efficiently and very specifically.  Both of these muscles are very much neglected in most general relaxation massage work.  The scalenes muscles are located in the base of the lower neck and attach to the first and second ribs, whilst the pectoralis minor muscles covers the 2nd, 3rd and 4th rib in the region of the front upper chest.  Both muscles although located respectively in the neck and upper shoulder region are often highly relevant in hand, wrist and arm pain pathologies, one of the main reasons behind this is that the brachial nerve plexus and its subsequent other  sub branching nerves serving the arm passes directly underneath both of these muscles so any tightness in either of these muscles is going to have a direct physical effect on creating nerve related aggravation in these regions.

[Trigger Point Pain Referral Pattern for Scalenes Muscle Group]

[Trigger Point Pain Referral Pattern for Pectoralis Minor Muscle]

Signs of nerve related impingement or over simulation can include pins and needles, intermittent shooting pains over a certain region (such as down the arm), electric shock type sensations, or areas of numbness.  Nerve impingement caused by the scalenes or pectoralis minor muscles can also cause the muscles and proprioception to misfire so causing symptoms of weakness or spasm in the arm, hand or wrist.  Symptoms of carpel tunnel or other repetitive strain injury type side effects can also be triggered or caused by soft tissue tension in these apparently unrelated areas further up and away from the hand, wrist and lower arm (but which you now know after having read this article and viewing the related videos are very much related).

Tightness in the scalenes muscles can cause tingling all the way down to the thumb and first fingers of the hand, whilst pectoralis minor tension cause refer tingling all the way down to the ring finger and little finger.  Constriction of the blood supply serving the arm from a tight pectoralis minor muscle can also cause feelings of coldness or lack of circulation to the fingers.

Habitual shallow breathing, particularly whereby the type of breathing only involves the use of the upper chest (rather than full deep belly breaths) is another potential cause of chronic tightness in the scalenes muscles.  Stress management through gradual build up practice of proper relaxing deep breathing is the perfect antidote.  Notice when you’re stressed or shallow breathing, be gentle and kind to yourself, congratulate yourself for noticing and just start by receiving 3 deep breaths in and out and build up that number over time, the idea is that over time it builds up to more of an unconscious habit rather than a conscious effort.

As with all these topic, there’s always so much that could be written or linked to, this is just what I could cobble together off the top of my head and without turning this into a fully blown dissertation as well as given the fact that I would like to go to bed in a moment (!!), but if you want to know more or have any suggestions I would be glad to receive your feedback as always and compile a part 2 or further subsequent parts as a follow on to this particular article as the demand unfolds.

Be well! 🙂

Email: info@isca-therapies.co.uk

Visit the ISCA Therapies website: www.isca-therapies.co.uk

19 January, 2011 at 00:13 3 comments

Muscles of the TMJ – Jaw Pain & Headaches

The TMJ or temporomandibular joint is the formal anatomical name given to the jaw joint, where the mandible bone (which forms the lower jaw) meets the skull (at the temporal bone).  There are a number of muscles which attach to and surround this joint and which are involved in mastication (i.e. chewing) as well as other facial movements involving the jaw.  Excessive chronic tension in the muscles connected with and surrounding the TMJ can cause not only local pain perception in the area of the jaw itself, but can also set-up pain referral patterns (through trigger points) causing regular experiences of headaches, migraines, involuntary teeth grinding (bruxism), gum or tooth related pain and even tiniuts (ringing in the ears).  Muscular tension or shortening in the muscle fibres resulting in restricted range of movement of the jaw joint can also cause pain and even a limited opening movement of the mouth itself (e.g. trismus).  Differences in the tensioning of the muscles on opposite sides of the face / jaw can cause uneven bite or malocclusion scenarios.

Physical trauma such as those caused by whiplash or other sudden violent impact to the skull or neck area can set-up chronic “holding” tension which then becomes “locked” into the muscles of the skull, jaw or neck as the body freezes itself up in that split second reaction of self defensive protection.  This tensioned holding scenario in muscles and related soft tissues (in any area of the body) is seen so commonly after many traumatic or sudden impact related situations (including high exertion force tooth extractions as well as many other invasive dental procedures).  What is not always commonly understood is that an effective and permanent unlocking of this tension will still not be permitted by the body itself long (week, months or years) after the perceived danger event has passed until it is satisfactorily notified that the threat has passed, and so in clinical massage therapy it is the goal to gradually introduce this notification of safety to the body to begin the process of gently unlocking itself; the muscles and soft tissues affected will be engaged in this process through safe, gentle, specific and highly focused manipulation and release work.

Apart from the physical conditions described above, unrelenting stress and emotional upset experienced by a person is another way in which muscles of the TMJ can become dysfunctional or become locked into a chronic pain pattern.  In fact, the emotional element is perhaps the most common underlying cause of TMJ dysfunction and pain, simply because there is an actual physical neurological connection between the sensory (as well as the motor) nerves within the TMJ itself which in turn interfaces with the brain and spinal chord via a branch of the Trigeminal nerve.  The feedback loop within this neurological pathway means that emotional stress can cause the muscles of the TMJ to clench or tighten up (quite a lot of people will unconsciously clench or even grind their teeth as a response to coping with or being faced with stress); likewise tightening up or clenching of the muscles in this area causes an increased perceptual registering of emotional stress to be generated in (the primitive reptilian part of) the brain and nervous system. So, as you can see that one feeds back into the other causing a potentially vicious cycle, until something comes along which can interrupt this cycle! Physical exercises which help to stretch and relax the soft tissues of the TMJ are a vital consideration as well as whole body and mind relaxation practices or activities in order to lower emotional stress and decrease sympathetic nervous system tone (and therefore increase the parasympathetic nervous system response).

As well as the perception of stress levels in our daily lives, history of invasive dental work and the related impact of other physical or emotional trauma, the type of food which makes up our diet can also have an effect.  The more prolonged and harder we have to chew our food, the higher the chances of the TMJ muscles becoming chronically tense.  Of course, as with any other set of muscles in the body, there are many effective preventative self care exercises and things that one can do in order to look after our TMJs and ease pain, preferable before it becomes chronic.

This video shows examples of just some of the self care exercises you can do in order to reduce tension in the muscles of the TMJ:

Chronic TMJ dysfunction and pain can respond very favourably to specific and effective physical therapy approaches such as clinical massage which mixes and combines elements from trigger point therapy, neuromusclar massage, myofascial release, stretching, acupressure massage, craniosacral therapy, as well as sometimes work with hydrotherapy to bring in soothing sources of moist heat and cold as appropriate all into the same session to suit the needs of the individual client.  Here is a very informative  article from a massage therapy trade journal written by a dental nurse who subsequently devised a unique clinical massage protocol for alleviating TMJ (as well as other jaw, teeth and headache) related pain conditions after training in clinical massage techniques herself and pooling this together with her dental nurse training:

TMJ & Clinical Massage Article (Today’s Therapist Magazine Dec/Jan 2009) – PDF File

Here is a very highly recommended website with lots of visual charts depicting the pain referral patterns that can be experienced and get set-up due to trigger point activity in muscles of the head and neck – have a look to see if the charts below match up with any pain patterns you might be experiencing:

www.triggerpoints.net/head-and-neck-pain.htm

A list of some the important muscles involved in jaw pain and movement restriction issues:

Masetter
Lateral Pterygoid
Medial Pterygoid
Temporalis
Digastric (plus others in the “suprahyoid” group)

These muscles are commonly indicated for frequently reoccurring headaches with pain radiating patterns which can be mapped out predictably by the person experiencing them:

Suboccipitals
Upper Trapezius
Sternocleidomastoid

Another informative site with TMJ related information and along with a helpful beginner’s musculoskeletal tutorial summarizing which muscles are involved in performing what physical movements of the jaw have a look at http://abbottcenter.com/bostonpaintherapy/2009/10/01/jaw-pain-and-tmj-final-details/

If you are interested in wading even more into some technical depth, this particular article is somewhat heavy on technical anatomical description and details, but well worth reading if you have the relevant background and want to investigate how and why clinical massage (and myofascial release work in particular) can help address TMJ related chronic pain issues:

TMJ & MFR Article (Today’s Therapist Magazine – Jul/Aug 2008) – PDF File

This entire article was prompted by some recent sessions I’d performed with a client to help them out with TMJ related pain including subconscious teeth grinding at night, regular headaches around the perimeter of the ears and down the side of the neck, malaligned bite and a very limited ability to open the mouth – so limited that opening the mouth to take a bit from a sandwich was virtually impossible such was the pain as well as just the physical restriction in range of movement of the jaw before we got to work.  Conventional MRI scans had not been able to shed any light on what was going for this client, yet we managed to produce a significant shift in jaw movement with decrease in pain from session 1 as well as reduction in teeth grinding at night, all to a degree which had not been experienced with conventional other treatments elsewhere.  Improvements continued in session 2 and session 3 will be next week (at the time of writing this article). Will aim to update with progress on this blog as we progress.  The protocols and techniques I use aim to produce effective and permanent shifts on a 4 to 6 session basis when performed on a weekly session basis – provided that the client also diligently follows the additional selfcare advice at home as well as attending the weekly regular sessions.

It has been reported by one particular source that 90% of musculoskeletal issues have an element of TMJ involvement to it, yet TMJ dysfunction isn’t necessarily the root cause (no pun intended).   “As a above, so below” provides us with a useful perspective from which we could spring board off of in order to begin looking at the picture of the body in an alternative and more holistic relationship, so according the Lovett Brothers Principle each vertebrae bone in the spine has is intimately related to a matching counterpart at the opposite end, thus the bones of the jaw, skull and neck have counterparts which they are affected by (and visa-versa) in the lumbar (lower back) and sacral areas of the pelvis.

TMD or TMJD (temporomandibular joint dysfunction) as it is sometimes referred to as is certainly a very big topic, I hope I’ve managed to cover as many of the salient issues  as possible here, but there is still so much more that I could say that hasn’t been raised in this particular article, so I would very much welcome your feedback, comments, questions and suggestions for amendments, additions and further articles on this topic.

Henry Tang (Clinical Massage Therapist) – Spaces of Possibilities Wellness Centre (Crows Nest, Sydney, Australia)

Visit the Space of Possibilities Web Page at: www.facebook.com/SOPcentre

Please leave comments below or email me at: SOPcentre@gmail.com

8 October, 2010 at 03:03 2 comments


Henry Tang – Therapeutic & Advanced Clinical Massage Practitioner (Crows Nest, Sydney, Australia)

Click image above to visit Spaces of Possibilities Wellness Centre, Crows Nest, Sydney, Australia.

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