The School of Natural Therapies
Training School for Massage & Holistic Therapies
ITEC Sports and Remedial Massage
ITEC Level 3
Submitted by: Khaleem Ash
Case Study 1
I have provided a treatment to a friend, Cxxxxx is of a slim build and 5′ 8″ tall. He has an office desk job and complains that he sits in a draft causing his neck to become tight and immobile. However, his lifestyle is very active, and he is a regular swim and gym goer.
His presenting problem was his lower back which had just been corrected by the osteopath. The facet joint had been re-aligned. The area that I found to be in need of treatment was mainly around the lower and upper back and neck.
On testing, the range of movement was limited in the lower back but was worse in the neck. The lateral movement, side to side of the neck was limited, restricting the turning, left and right. Extension and flexion of the neck was tight, but not limited to any great extent. Visually his shoulders were raised towards the ears indicating tight Trapezius muscles.
We discussed the situation and decided on the following plan:
- To treat neck and shoulder muscles with neuromuscular and myofascial-stripping techniques to release deep muscle tension and improve neck movement.
- To search for any trigger points that may be causing the pain and making the condition be so resistant to treatment.
- To use movements to help to balance muscles.
The aim was to release the tension in the muscles of the lower and upper back and neck with the body in a prone position, I warmed the muscle of the back, using the classical massage movements of Effleurage and then Petrissage the soft tissue as preparation to go deeper.
I started with the lower back, checking the Erector Spinae group. When I found some micro knots, I used NMT (neuromuscular technique), that is holding the thumb (no longer than 30-60 seconds). on an area of discomfort until it fades. This is repeated several times until it has faded.
Superficial Effleurage: This was the first initial movement and touch to start the psychological relaxing and putting my clients at ease and which also enabled me to spread the medium over my clients body, it will also warm the tissue for further work to be carried out in the session, I also used this technique in between other techniques to link and flow so as to make my client feel relaxed and to have hands on as much as the time as possible. Th is technique starts to increase the local flow of blood and lymph, stimulates nerve endings and starts to improve circulation this is all specific to my client’s needs to start to have a sense of well-being and relaxation.
Deep Effleurage: I then used Effleurage to further improve blood and lymphatic circulation and to relax any contracted muscles, this technique also aids in the body of ridding waste and to aid the venous return, my client had stated that he prefers a firmer pressure for their comfort also the wellbeing affect this technique has and to enhance all my clients’ bodily systems, and to release any contacted muscled. I also used this technique at the end to improve the circulation within the area, assist in the removing of waste and bringing in a flow of fresh oxygen and nutrients to my client’s system.
Petrissage: I used this technique with varying pressure by using my hands, heal of hands and Ulan Border (forearm) for my client’s needs it is a kneading motion to relax loosen and stretch muscle, tissue and fascia, given that my client would like more relaxation, suppleness and flexibility, this technique will release the tension and I felt this may also go to some way of being a preventative measure for my client helping to prevent any future injuries, the release of tension, the increased blood flow and lymphatic drainage can only benefit my clients physiological and psychological wellbeing.
Wringing: I used this technique using hands and heal of hands on my client to promote a relaxation effect, it assists in the warming of the area by increasing the blood circulation and to stimulate the release of feel-good hormones to help stimulate the nervous system to provide a sense of calmness to help my client to relax more.
Percussion movements: These have a tonic effect on the muscle fibres and helps create vasodilation this assists with the maintenance of healthy muscles; vasodilation increases blood circulation around the body carrying essential oxygen and nutrients needed to keep muscles strong and healthy and to prevent injury for my client.
Muscle stretching technique:
I used this technique during the massage once the muscles had been warmed using the above techniques, stretching on the muscles away from their attachments causing the fibres to lengthen helped to pull out some of the tension within the muscle fibres. This helping to improve my client’s suppleness, flexibility, and range of movement. Using this technique will also help prevent the risk of injury.
Effleurage is followed to clear the area of waste and to warm down the muscle. Lot of knots were found, mainly in the lower back area. I then palpated the Quadratus Lumborum muscle group responsible for most of the lower back pain. I found a number of small knots and eradicated them using NMT.
Having treated the Erector Spinae and the Quadratus Lumborum muscles, I then progressed to the upper back, Rhomboids, and the Upper Trapezius after preparing the area with effleurage and petrissage. Small knots were also located on the upper Trapezius leading into the side of the neck on both sides.
I again found lots of micro knots using NMT and eradicated many by using soft tissue release (stretching the muscle whilst using NMT) some of which was very painful, so I used soft tissue release, (rocked the limb whist holding the thumb on the knot) until the knot cleared.
I then checked the neck and the body in a supine position, then, I used some manipulation to check the Range of Movement of the neck. This the RoM was very limited laterally so I used a series of stretches. This improved the flexibility of the neck. I then finished with some neck warming massage.
After-care Advice – Stretching
Several stretches were shown, to be done mornings and evenings. I suggested side stretches for the Quadratus Lumborum, a couple of stretches for the Rhomboids and the neck to help maintain the improvement and to keep the muscles flexible and the skeletal system stable.
Cxxxxx was very happy with the treatment. He visits regularly so that he can continue with his other workouts. He also visits his Osteopath regularly and believes that his musculature was in the best condition he had seen.
Self-Reflection: I was extremely pleased on how Cxxxxx responded to the treatment. I suggested Cxxxxx may benefit from meditation or yoga for his stress levels and take time out of his busy schedule for himself. He said he would look into these things. I feel even a small amount of quality time for himself could make a huge difference to Cxxxxx’s wellbeing and overall muscular tension and tightness. I re-evaluated Cxxxxx’s posture, and his shoulder alignment was also now perfect.