• Myofacsial trigger points
A trigger point is a hyperirritable spot usually within a taut band of Skeletal muscle or located in its surrounding fascia. There are different types of trigger points: active, latent, primary, secondary and satellite. Although trigger points and acupressure points or shiatsu points are not the same there appears to be a close correlation. Trigger points can often mimic condition like cardiac pain, osteoarthritis, tendonitis or bursitis. Quite often clients will present trigger points in the sub-occipital (base of the skull) muscles, which in turn will result in migraine headaches. Trigger points can be treated through a few different approaches: Moist heat, ischemic compressions, and repetitive muscle stripping or origin and insertion techniques.

• Strain, sprain, spasm, contusion, and contracture
A lot of people use these words interchangeably without realizing the significant difference. A strain is muscle involvement, while a sprain is ligament. (Each one having possibly different degrees) A spasm is when an entire muscle has a convulsive contraction. (Sustained or alternating). A contracture is a static muscle shortening due to spasm or fibrosis which causes loss of muscular balance. A contusion is a mechanical injury resulting in hemorrhage below unbroken skin. All of these, depending at which stage of injury, can be treated with massage therapy, by which the healing time is greatly increased. Certain orthopedic testing can be performed to determine the specific type of injury.

• Knee related injuries
The knee is the largest joint in the body, being a hinge joint. It is prone to high incidence of injury due to its location, complex motion and lack of protection by muscle or fat. There can be different types of injuries. I.e.; cruciate ligament, (Ant. and Post.), Collateral, (med. and lat.), meniscal tearing or simply muscular. Different orthopedic testing can be performed to the client to differentiate cause problem. I.e.; Valgus and Varus stress test, Ant. And Post. Draw test, Appley’s compression and distraction, Mcmurrray’s and Helfet. There also can be certain signs and symptoms, which are observed and noted in the case history. I.e.; Edema, inflammation and limited range of motion. The therapist then works the muscles compensating the compromised joint. Seeking out any adhesions, scar tissue or trigger points. I.e.; Iliotibial band, rectus femorus, etc.) If inflammation is still present a lot of lymphatic drainage and swelling technique is used.

• Tendonitis, bursitis
Tendonits is quite common in a lot of people without us really knowing, except for that tender spot near a joint that is often overused. The tendons, which join the muscle to the bone, become irritated and inflamed. Tenosynovitis is roughening of the gliding surfaces in their synovial sheaths. This is where joint crepitis is present. I.e.; Rheumatoid arthritis. The therapist should recognize an acute stage, ice and appropriately massage. If chronic, muscle stripping along the belly of the muscle and pressure points are applied at the attachments. In some cases cross fiber fractioning is necessary. If treating tendonitis the tendon should be positioned in neutral. If condition is tenosynovitos the tendon should be taut. Common and specific tendons treated are; Common flexor and extensor, Subscapularis, Supraspinatus, Infraspinatus and Long head of biceps. Bursitis is the inflammation of a bursa. A bursa is a small fluid filled sac located in the places of tissue where friction would otherwise occur. I.e.; b/w tendons and bony prominences. Some causes of this may be; overuse, bacteria, trauma or Inflammatory disease. Some signs and symptoms may be pain or even a visible lump. Locations; Shoulder-subdeltoid/subacromial, Knee-infrapatella, suprepatella and prepatella, Leg- lateral gastrocsnemius, Hip- ischial; trochanteric, and Elbow-olecranon, The therapist uses a lot of drainage techniques and gentle frictions over bursa to relieve adhesions. Maintaining mobility, stretching and strengthening are important remedial exercises for both tendonitis and bursitis.

• Migraines, fibrocystic headaches
Many people suffer from one or the other or even both they just don’t know the difference, why and what the cause is. A fibrositic headache is otherwise known as a “tension” headache. Clients usually complain of pain associated with sub-occipital region (neck), face and other parts of the head. This type of headache can also be systemic toxicity. i.e.; constipation, alcohol or even organ dysfunction. Musculoskeletal pain to the head can be referred from muscles, joints, fascia, bones or ligaments. A migraine is vascular in nature. (abnormal vasoconstriction/dilation of the arterial blood vessels in the head) It is excruciating and can be accompanied by nausea, vomiting, and/or blurred vision. There are 2 types: classic with or without aura and cluster. Some trigger factors could be hereditary, dietary, allergies or sensory stimuli. For a therapist quite often medication can indicate the type of headache the client experiences. Common migraine medication is Foirnal and Tylenol. Some may be an analgesic while others are strong vasoconstrictors, necessitating hydrotherapy or technique modifications for the therapist.

*Chronic analgesic use may cause “rebound headaches” in which the headaches are perpetuated by medication usage. A massage should never be performed during a migraine; this will only increase vasodilatation which in turn will increase the pain. Cold compresses are suggested at this time. Between migraine headaches and for tension headaches the therapist should focus on relaxation, reducing musculoskeletal hypertonicity, adhesion, and joint dysfunction of the cervical spine. A passive range of motion and stretch are beneficial in increasing mobility. Contract/relax technique can be used to increase the length of any shortened muscles. For chronic tension headache quite often the pain can be referred from a specific muscle. This is why it is important the therapist is familiar with referral patterns of trigger points. An assessment test can be performed to rule out meningitis. (I.e.; Kerning’s) Hydrotherapy is very helpful in decreasing the tension for the muscles surrounding upper thorax and cervical spine; often a warm towel, whirlpool, hydrocollator or thermaphore can be applied. Warm footbaths are good; this draws the blood away from the head. Lavender and peppermint are essential oils that have proven to help with a tension headache.

• "Shin splints", Compartment Syndromes
Anterior Compartment Syndrome
This is chronic pain felt in the front part of the tibia from repetitive overuse. The muscles involved are tibialis anterior, extensor hallucis longus and extensor digitorum longus. (peroneus tertus and peroneal nerve become compressed b/w fascia and the tibia and the fibula) These first 3 muscles hold up the forefoot. During foot decent during running and contract eccentrically after heelstrike. These muscles oppose larger antagonists (gastrocs and soleus). Therefore improper gait, running up hills and on hard surfaces could be a strong attribute to this. Condition. It is important for the therapist to strip along these muscles from origin to insertion. Manipulations should be toward the tibia. It is important also that the therapist passively stretches this out. (plantarflexion and inversion/eversion) If there is severe swelling is present ice. If continued perhaps and M.D. specializing in Sports medicine should be sought.

• Frozen shoulder
This is a term used when the scapula adheres to the thoracic cage. Otherwise known as Adhesive Capsulitis. This causes severe restriction in the shoulder joint. Certain conditions can lead to this i.e.; osteoarthritis, systemic infection, trauma or trigger points in associated muscles. The therapist through checking postural assessment makes Observations. Later testing can be done to see if a tear is present, bursitis pathology or capsular pattern of restriction. i.e.; Apley’s Scratch test. Massaging a client presenting such focus on all the compensating muscles of the shoulder girdle. Mobilizing techniques to the thoracic spine in case of hyperkyphosis or hypermobility in the thorax. Joint play to the scapula is necessary as well passive range of motion. Remedial exercises are given to carefully lengthen specific muscles. Those suffering from any disuse atrophy should primarily focus on increasing range of motion.

• Whiplash
This is due to a rapid movement of the head relative to the body. These types of injuries often involve vertebrae, discs, nerves, fascia and blood vessels. The cervical spine is the most flexible part of the entire spine, therefore is very susceptible to acceleration and deceleration impacts. Depending on the severity of the whiplash, it is always a question to whether or not the client has been assessed by an M.D. It is also important to determine at what stage is the injury? (Acute or chronic) A few tests are performed after a case history is reviewed. i.e.;

Spurling’s Test (foreamen compression) Swallowing test. Depending on the direction of impact different muscle groups will be affected.

Extension Injury: Scalenes, levator scapulae, longus collie, and rhomboids.

Flexion Injury: Upper trapezius, splennius capitus, superior nuchal ligament and other intrinsic neck muscles.

Rotation Injury: Sternocleidomastoid, suboccipitals and splenius cervics.

If inflamed edema is treated by lymphatic drainage, light repetitive effleurage. If chronic, ( the injury has subsided, 3 weeks after trauma) deeper work can be done to treat areas of restriction and residual adhesions or trigger points or joint dysfunction. Hydrotherapy is an excellent treatment in this case. I.e.; Acute (first 72 hours) ice and cold compress Sub-acute (3 days –two weeks) vascular flush (warm and cool) Chronic ( 2-3 weeks) deep moist heat When the client is in a chronic stage the key remedial exercise here is to restore length to the shortened muscles and strengthened the weakened muscles.

• Temporalmandibular joint dysfunction
“TMJ” this is common amongst a great deal of people, its just to what severity and how much pain and discomfort is it causing. This pain can be unilateral or bilateral around the ear, teeth , head or joint itself. Muscle tenderness, joint clicking, headaches and limited range of motion are often involved. There are several factors that could cause “TMJ” just to name a few; bruxism (teeth grinding) jaw clenching, improper jaw motions or even prolonged dental work. Like the knee this joint is a hinge joint. There is a fibrocartilage disc that separates the mandible and temporal bones, which divides two synovial joint capsules superiorly and inferiorly. The muscle responsible for opening the jaw is the lateral pterygoid. (external) The upper portion of the muscle attaches to the articular disc – which contracts it and pulls the disc forward. Range of motion is checked as well protraction and lateral movements. Muscles that elevate the mandible are; masseter, temporalis and medial pterygoid. Muscles that depress the mandible are; lateral pterygoid, diagastric, supra and infrehyoids. Vertigo and tinnitus or earaches may be some symptoms. The primary goal for the therapist here is to not only restore optimal joint mechanics of the TMJ but to restore strength to the depressors of the mandible, especially the lateral pterygoid. Upon the clients request intra-oral work can be performed as latex gloves are worn. (medial and lateral pterygoid can be palpated more thoroughly) The therapist also focuses on massaging neck, scalp and face. This is done by longitudinal strippings. (along scalenes and SCM) Deeper pressure can be used to treat the superior attachments of the suprahyoid muscles at the mandible. Home exercise are given to strengthen muscles of mastication. Deep moist heat is recommended to cervical muscles. If inflamed apply ice compress.

• Osteoarthritis
This otherwise known as a degenerative joint disease. It is characterized by progressive deterioration and loss of articular cartilage. Some causes may be; aging, obesity, overuse or insidious. This affects weight bearing joints and quite often affects women more than men after menopause. Sometimes nodes are present at the distal and proximal joints of the extremities. (herberdens and Bouchards). Massage is excellent from those with this arthitic condition. The goal for the therapist is to decrease pain and spasm while increasing range of motion. Circulation will also be increase which will slow down degeneration and atrophy. Paying special attention not to work over any bone spurs the therapist performs deep pretissage, frictions and drainage. Lots of mobilization and passive movement are essential. Some hydrotherapy recommended would be warm Epsom salts baths, whirlpool and sauna for general stiffness. If inflammation is present cool applications can be applied. The therapist can recommend some home remedial exercise i.e.; walking and swimming.

• Degenerative disc disease
Between each of the vertebral bodies of the spinal column we have discs, which are broad but flattened and fibrocartilageous (their make-up). The center part of the disc is called the nucleus pulposus and the outer part is called the Anulus fibrosis. This is important to know in knowing the difference between a herniation and a prolapse.

• Disc herniation
Disc herniation is when annular fibrosis tears and the nucleus pulposus is displaced and bulges out placing pressure on the posterior longitudinal ligament. ( the outer fibres not to badly interrupted)

*Disc prolapse is the tearing of the inner and outer annular fibres of the disc so the nucleus bulges into the neural canal compressing a nerve root. Certain orthapedic tests can be preformed to differentiate. i.e; Kemp’s test. (for cervical; Spurling’s test)
Testing (see; assessments) can be done also to determine at which level the spinal nerves are actually impinged.

Nerve root irritation causes a sharp, local or deep aching pain. If the client unsure of any preexisting problems it is always wise to check with an M.D. or Chiropractor for any concerns. The therapists’ job is to decrease pain from trigger points, hypertonic or spasming muscles. This is the long run will reduce muscular imbalance and possibly reduce the progression of degeneration affecting the intervertebral disc. Gentle tractioning, mobilizing of the thoracic spine and shoulder girdle and ischemic compressions of the tendinous attachments of the cervical muscles at the occiput. Scar tissue may need to be broken down after any surgery. If segments have been fused it is important no to mobilize the hypomobile segments surrounding the fusion site. Stetching and strengthening is imparative . Gentle repetitive flexion/extension exercises will help normalize muscular tone and joint mobility. Hydrotherapy; deep moist heat will increase the circulation to the hypertonic muscles adjacent to the affected vertebral sements. In case of an acute muscle spasm ice packs can be used.

• Fibromyalgia
This is a syndrome otherwise known as fibositis. This is wide-spread muscoskeletal pain. There are several localized tender points (11-18). The signs and symptoms would be pain for more then 3 months and disturbed sleep paterns. Depending on how the person is using their body, “tender areas “ may change. Fibrositis may occur on its own or concurrently with an arthritic disease. This tends to run in families and affects middle-aged woman 10:1. Some symptoms may include swollen glands, high/low temperature and lack of endurance. Tests for this, include pressure to “tender points”. Massage Therapy is excellent for this syndrome. Some of the aims of the therapist are to prevent or reverse muscle atrophy due to disuse and relieve muscle spasm and stiffness. Deep tissue, slow soothing massage is quite beneficial not only to the tissue but assisting to the irregular sleep patterns. Light aerobic exercise such as walking is good to maintain. Anti inflammatory drugs are not appropiate as there is usually no inflamtion. Hydrotherapy; persons suffering with this do not respond well to cold. Heat and whirlpool are a good recommendation.

• Osteoprosis
info. Yet to write

• Chronic fatige syndrome
info. Yet to write

• Lupus erythematosus
info, yet to write

• Inflammatory arthritides, i.e, ulcerative colitis and crohns disease
info, yet to write

• Scoliosis
This is a lateral deviation of the spine. It may be present in the cervical, thoracic or lumbar region. Scoliosis may be functional or structural. When functional (postural) this means it is only 1st degree and can be straightened or reversed.
Structual is 2nd or 3rd degree which indicates connective tissue and/or bone change which cannot be reversed, except through surgery or casting.
This ailment involves a thorough assessment and case history to determine the severity, progression and cause.
With a “C” curve only one curve is present. With an “S” curve two or more are present. The apex of the curve is always the furthest from the midline. Scolioses are identified by the convexity of the curve. (roation of the vertebral bodies rotated towards the convexity, spinous processes towards concavity) This is important for any massage therapist to recognize in order to focus on stretching the shortened structures and apply deep longitudinal strippings to the concavity, while stimulating manipulations to the overstretched. convexity..
To eliminate spinal lesions a few orthopedic tests are preformed. Ie; Straight leg raise, Valsalva’s or Kernig’s.
When massaging special attention is focused on erector spinae and quadratus lumborum muscles, seeking out any fibrosis or contractures.
Hydrotherapy is excellent applying deep moist heat to contracted structures and cold to stimulate the weakened structures.
It is essential when the therapist is performing remediation exercises to focus on stretching out pectoralis, iliopsoas, and latissimus dorci.
Self-care exercises will also be provided for this concern.
Some contraindications for the therapist, clients should be aware of is; not attempting to mobilize any fused segments or Harrington rods.
Heat should be avoided over rods.
Massage therapy is excellent for scoliosis.

• Pregnancy
A lot of people question the fact if massage is possible during pregnancy or not. This is a very important time for massage but a lot of precautions should be taken. The body not only goes through physical and emotional changes but musculoskeletal. As well several complications can occur during this time and it is important that any other human being touching your body should be aware of this.
i.e; toxemia, eclampsia, phlebitis or diastasis Recti..
Before massaging a pregnant women a thorough postural assessment should be taken. The body’s center of gravity shifts upwards and forwards due to fetal weight increase and weight shifting to heels.
An anterior pelvic tilt with lumbar lordosis is present while external rotation of the femurs increase knee hyperextend and pes planus may be present.
Including blood pressure. An abdominal massage is contraindicated during the first trimester. Some of the most common ailments these women have are; edema, piriformis synmdrome, carpel tunnel and hyperlordosis. This is why it is important for the therapist to know and fully understand all associated conditions involving pregnancy.
Massaging positioning will be accomidated as to how far along the pregnancy. Towards the end of the pregnancy supine position may not be comfortable because of the weight of the fetus. The client may wish to be side lying. Sometimes a small towel or pillow is placed under the right hip, this is to avoid any extra pressure on the diaphragm or abdominal aorta.
Heat pacs to low back and vascular flush to legs and feet help to reduce edema. Cold cloths may be place around breast area to reduce congestion.
Home remedial exercise are recommended; i.e; Buerger’s exercise for edema/varicose veins.
Not only is massaging optimal for relaxation while pregnant but it also helps many other discomforts.

• Pes Planus
This is also known as Flat feet. The longitudinal arch of the foot has fallen. Anatomically the talar head is placed medially and planterward. Some causes of this might be; genetic, trauma, improper gait or shortening muscles of the lateral leg. There are three degrees of flat feet. (normal till weight bearing, rigid/some boney changes and an arthritic foot with marked changes in the joints. )
This is primarily a condition of weakness, while the foot is often everted and peroneal muscles shortened.
Massage is preformed by thoroughly working the legs and compensating muscles. ( concentrating on muscles that support the medial arch) Joint play and passive mobilizations of the ankle and foot. Resist/hold isometrics strengthen the weak structures.
Warm foot baths are recommended.
Some beneficial home exercises are; picking up pencil with toes and toe walking.

• Pes Valgus
This is lnown as “pronated foot”. The bone is everted (calcanium)
Forefoot is abducted. Some of the causes to this may be “bowed”
Tibia, obesity or tight achilies tendon.
The direction of the foot is eversion
The action is pronation.
Massage treatment is the same as Pes Planus.

• Pes Cavus
This is known as “Claw” foot, it is an abnormally high arch. This is often accompanied by claw toes.
Anatomically the Medial longitudinal is exaggerated and the metatarsal heads are dropped. This may be caused from wearing shoes too small during growth, contraction of plantarfascia or arthritis. There usually is inversion, adduction and suppination. Massaging these feet is usually releasing the plantarfascia and stretching the shortened structures. Good home exercises for this is dorsiflex the foot and spread the toes. Suggestions for this foot for shoes to be worn may be orthotics or just shoes with extra toe room and a slightly raised heel.

• Hammer Toes
This is flexion at the proximal interphalangeal (knuckle)
May be congenital or hereditary.
Massaging these type of feet focus should be put on extensor digitorum longus and brevis as it is in contraction. Joint mobilization and deep work to the dorsum of the foot. Home exercises should focus on stretching the dorsal surface.

• Plantarfascitis
This is when there is pain and tenderness in the plantar aspect of the fool, in the arch or the heel.
Anatomically the plantar fascia (plantar Aponeurosis) attaches to the calcaneus and the heads of the metatarsals. The fascia is usually stretched. Common site of inflamtion is the medial tubercle of the calcaneus.
Some common causes for this may be prolonged standing or walking, perhaps poor biomechanics are present or improper shoes.
Pain will present itself just anterior to the heel and usually most painful in the mornings when the foot hits the floor.
A heel spur may develop if repeated inflammation induces ossification.
An active resisted strength test can be preformed to see if there is pain. .ie; toe walking
Massage therapist should focus on first if in acute decreasing inflammation. If chronic restoring full muscle length and strength to both anterior and posterior compartments.
Thumb kneadings to the attachment of the fascia progressing to fractioning within client’s pain tolerance. Frictioning is always contraindicated if the client is taking any kind of anti-inflammatory.
Joint play can be preformed to foot and ankle articulations.
It is important when massaging that the therapist seek out the tight and weak muscles as well as adhesions, this could be a main attribute to improper gait.
Therefore a long term aim is to restore proper bodymechanics to the foot, ankle, knee and hip.
Therapist can perform passive-relaxed stretches to the gastrocnemius and plantar fascia.
Home remediation exercise are given to strengthen the intrinsic foot muscles. Arch supports may be recommended if the condition is resulting from foot pronation.

• Hyperkyphosis (insert pictures from tx. Book)
This is sometimes called “hunchback”
Anatomically this is an excessive curve of the thoracic spine it is usually accompanied by protracted scapulae and forward head posture.
There could be a few different causes for this; i.e; habitual bad posture, occupation, slef-conscious about height or even a bone problem. (osteoprorosis, rickets)
It is important that the therapist do a postural assessment observeing all the different muscular imbalances.
The goal for the therapist is to focus on deep work anteriorly.(pectorals intercostals).
The neck muscles should be worked thouroghly due to head carriage.
When the client is lying prone (face down) it is helpful to place rolled towels under the shoulders to keep them from rolling further forward.
More of a brisk massage should be preformed to the upper back
(rotator cuffs and serratus posterior).
The main goal here is to open up the chest to try to decrease the kyphotic curve.
Several remedial exercises are given for this as well as passively stretching.
Hydrotherapy would be good in applying heat to the front of the chest to relax the muscles and a vascular flush predominately cold to the posterior thoracic area to stimulate the muscles.

• Hyperlordosis (insert picture from tx. Book)
This can also be called “swayback”
Anatomically there is an abnormal convexity of the lumbar spine. The pelvic is tilted forward increasing this lordotic curve. This can be postural or structural. (3rd degree structural involves serious bone changes and can be changed only through orthopedic surgery)
The abdomen may appear protruberant.

• Hypertenson
This is when blood pressure exceeds 140/90. Anatomically systolic pressure (high pressure) is when the heart beats. This is the ouput of the blood into the aorta, when the heart contracts. Diastolic pressure (the lowest) is when the heart relaxes. This is when the atria fills with blood. With the function of the aortic valve and the elastic condition of the arteries and arterioles this enables them to except blood from the aorta.
There are two types of hypertension: benign and malignant.
Benign is silent and long term with an idiopathic etiology.
Malignant is secondary to another pathology, i.e; diabetes, kidney and liver disease. This is more rapid in progression.
Some causes for this could be; oral contraceptive, toxemia in pregnancy, alcoholism, obesity or exacerbated by stress.
Some signs and symptoms may be flushed face, headaches or anxiety.
Blood pressure should be taken before receiving a massage if the client has any type of history pertaining to this. If the blood pressure exceeds 160/95 this could indicate a problem and should be referred to an M.D. The goal of the therapist is to decrease stress and provide relaxation. It is important that the therapist does not elevate limbs, perform stimulating or painful manipulations. An abdominal massage is contraindicated due to increased portal circulation.
Hydrotherapy should consist of cool towel around the neck and over the heart. There should not be any heat applied to the head, including pacs, thermaphores or hydroulators.
Relaxation exercises are recommended.
Massage is the most benefical to those whose hypertension is induced by anxiety.

• Raynauds Phenomenon and disease

• Deep vein thrombosis

• Varicosities

• Congestive heart failure

• Sinusitus

• Chronic bronchitis

• Emphsyema

• Asthma

• Sciatica
Sciatica is a painful condition with pain referring down the posterior aspect of the leg.
What is happening is the nerve is being entrapped or compressed. Its nerve supply comes from L4-S3. It is the largest nerve in the body, which later divides into two. (common Peroneal and Tibial)
When this nerve is entrapped it is important for a therapist to alleviate the specific muscles (primarily at origin and insertion). Areas of compression may be as follows; under the piriformis (between fibres if nerve pierces it), between hamstrings, under gluteus maximus or in front of the Sacroilliac joint.
Motor supply is to the hamstrings and all the muscles of the leg and foot.
Sensory supply to entire thigh, leg and foot except for the medial thigh.
There could be several causes for this.
Perhaps; muscle tension, disc herniation, osteophyte formation, or hip dislocation.
Massage and remedial exercise have excellent results for this condition.
Through assessments positive testing from Straight leg raising test, Kernig test and Valsalva’s Maneuver.
Hydrotherapy applied; acute stage-ice
chronic- moist heat to relieve spasm/tension

• Carpel tunnel syndrome
Carpel tunnel is compression of the median nerve. The reason it is called “tunnel” is because the nerve runs through an area of tendons, sheaths and retinaculum, when inflammed causes irritation of the nerve.
Some of the causes are; overuse, pregnancy, injury or trauma.(colle’s fracture)
Median nerve roots from C5-T1 of the spinal column.
The therapists job is to alleviate all the tension in the forearm flexors.
This is done by deep strippings along the muscle recognizing the origin and insertion. Often fractioning along the retinaculam, joint play of the carpel bones and passively stretching, will also be benefical.
Some positive testing that determine this condition are; Phalen’s, and Tinel’s .
Home exercises are given to stretch the muscles compresing the nerve.

• Thoracic outlet syndrome
This is a syndrome involving compression or pressure on the brachial plexus. ( A network of nerves extending from the neck to the axilla C5-T1) This can be caused by bony, ligamentous or muscular obstacles accompanied by blood vessels.
Anatomically certain compressions could involve; scalenes, pectoralis minor and subclavian vein/artery, clavicle and first rib.
Some causes of this may involve trauma from lifting or straining, loss of tone in elevator muscles, fracture of the clavicle or an enlongated cervical rib.
Signs of this may be pain in the fingers, hand, forearm and shoulder. (median nerve distribution).
Some vascular manifestations may occur; decreased circulation to hand, coldness, edema and weakened radial pulse.
Orthopedic testing can be preformed to determine location of compression. (Adson’s, wright’s of costoclavicular test)
The primary aims for the massage therapist are to relieve tension, retrain posture, increase range of motion and break down any adhesions. It is very important when working on a client not to let the arms hang off the table or to put pressure on a nerve particularily one that is stretched. Mobilization of the scapula is very beneficial as well as joint play of the gleno-humeral. A lot of passive work on the neck including stretches. Lymph drainage may be necessary.
Remedial exercises are given to client. Including scalene stretchs, strengthening trapezius, and pectoralis stretching.
Hydrotherapy recommened would be heat or a vascular flush.
Quite often cold may increase nerve pain.

• Neuralgia and neuritis

• Bell's and Erb's Palsy

• Nerve lessions

• Klumpke's Paralysis

• Cerebral palsy

• Multipe sclerosis

• Parkinsonism

• Spianl cord injury

• Hemipeligia

• Poliomyelitis

• Diabetes mellitus

• Cancer

• Human Imunodefiency Virus

• Constipation

• Edema

• Wounds, burns and scars

• Skin pathologies

• Decubitus ulcers

• Dysmenorrhea