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((Perform a massage of the neck and right arm. Client is presenting with:
1. A muscle spasm and muscle shortening in the right arm flexor that also flexes the GH joint;
2. Stress due to his enormously-long-ridiculous-absolutely-not-in-any-way-related-to-Jewish-holidays reading week;
3. A trigger point with a referral pattern from the occiput to the orbit of the eye (suboccipitals);
4. A muscle spasm in the major right arm abductor.
You have twenty minutes to complete the OP.)
Hello Simon,
My name is Alex and I will be your student therapist today. I've just come from washing my hands. I understand that you are feeling very stressed out right now. I'd like to begin by teaching you some deep diaphraghmatic breathing techniques to assist in relaxing you today. Do I have your permission to touch your stomach, your ribs, and your upper chest? Thank you.
I'd like you to start by taking a deep breath through your nose into your stomach, here [placing hand on stomach]. Try and fill your stomach as much as possible, pushing my hand out. Now let the breath out through your nose. Good. Now [touching the hands to the lower ribcage] try and push my hands out by breathing into the sides of your ribs. Now let your breath out through your mouth. Now take a deep breath into your upper chest [placing hand on breastbone]. Good, now let that go. Now we're going to combine the three in the order we just did. Try and do them slowly. Ready? [touch stomach] Into the stomach, [touch ribs] ribs, [upper chest] and chest, and now out. Good. If you find yourself getting stressed, try doing this to help you relax.
I'm going to begin the massage with your upper chest to increase the blood flow to your arm and neck. From there I'll work on the shoulder that's bothering you, then the arm, and then I'll finish up today with the neck. Is that OK?
Is it painful for me to massage the shoulder and arm on the right? No? Great. [While massaging the upper chest and the arm] I understand that you're having a muscle spasm in your shoulder. This is most likely caused by your deltoid. I would like to do a technique with you that should help reduce the spasm. It is called the "Origin and Insertion" technique. The way it works is that when your muscle is being used, it has receptors that tell it to relax. This technique stimulates those receptors so that it will relax, making the spasm relax too. I will be using a my thumb to make Xs over the origin and insertion of the muscle to do this. I will use a moderate pressure, but if you find it is too deep, please let me know and I will do it more gently. Is this OK with you? Do you understand? [perform technique]
[Massage upper arm some more] I also see that you are having some spasming and tightening in your biceps. I can perform a stretch that will help with that. It is called 'Agonist Contract'. It should cause more pain, so if it does, let me know. And please keep breathing normally throughout. If you could please shift over so your arm and shoulder are off the table, thanks. You can hold on to the other side if it makes you feel more secure. I'm going to gently take the muscle into what is called the first barrier of stretch. [do so while stabilizing at shoulder] Now that I'm here, when I say GO, I'm going to ask you on your next breath in to try and bring your arm back like you're trying to bowl. I'm going to prevent you from doing it and we're going to hold that for 10 seconds. OK? Go. [isometric stretch 10 seconds] And on your next exhale, relax. Great. I'm going to take it a little further now until I feel more resistance. There. And on your next inhale, please try to "bowl" again while I resist. Go. [10 seconds] And relax. You're doing great. I'm going to bring it back a little further. And please "bowl" one more time. [10 seconds] Keep breathing normally, you're doing great. And relax. And now I'm going to take it into the full stretch that I can and we'll hold it there for 30 seconds. Here we are. [15 seconds for OP purposes, then gently return arm to resting position and perform effleurage]
Now I'm going to work on your neck. [While massaging] You've said that you're feeling headache-like pain across the side of your head, right? This is often caused by a "trigger point" in a muscle group called the sub-occipitals. A trigger point is a little bit like a muscle spasm, except that it only happens in a few fibers of a muscle and causes a "taut band". We treat them by placing pressure directly on the most tender point and holding it for 30 seconds to 2 minutes or until the muscle releases. This can sometimes cause immediate pain, but that shouldn't go above a 7 out of ten. The pain scale goes from 1, which is no pain at all, to 10, the worst pain you've ever felt. I can feel a tender nodule right here. Does it recreate that pain you described when I press on it? Yes? OK. Now that I've explained the therapy to you, do you want to go ahead and have it treated? Great. So I want you to keep talking to me. Is this the most sensitive spot? Yes? When I press on it, where is your pain at? A 7. OK. Take a deep breath in for me. And out. Is the pain level going down as I hold it? Yes? Where is it now? A 5. OK, we'll keep going. A 3 now. Great. We're almost done. And a 1... there, I felt it release. OK, we're going to do a flushing of the muscle [massage] and a stretch to help release the trigger point. I'm going to press down on your forehead - please glance at your toes for me. Perfect, and we'll hold this for 30 seconds. [15 for the OP]
[While massaging neck more] When you get home tonight, try and place a hot pack on your neck, or warm moist heat - like a hot shower on your neck. Try to make sure your glasses are adjusted properly and not to look up at too many things. Maybe look at your computer set-up and make sure the monitor is at the proper level for you, and try not to overuse your arm for the rest of the day. OK? Have a great day, Simon.
[and fin]
1. A muscle spasm and muscle shortening in the right arm flexor that also flexes the GH joint;
2. Stress due to his enormously-long-ridiculous-absolutely-not-in-any-way-related-to-Jewish-holidays reading week;
3. A trigger point with a referral pattern from the occiput to the orbit of the eye (suboccipitals);
4. A muscle spasm in the major right arm abductor.
You have twenty minutes to complete the OP.)
Hello Simon,
My name is Alex and I will be your student therapist today. I've just come from washing my hands. I understand that you are feeling very stressed out right now. I'd like to begin by teaching you some deep diaphraghmatic breathing techniques to assist in relaxing you today. Do I have your permission to touch your stomach, your ribs, and your upper chest? Thank you.
I'd like you to start by taking a deep breath through your nose into your stomach, here [placing hand on stomach]. Try and fill your stomach as much as possible, pushing my hand out. Now let the breath out through your nose. Good. Now [touching the hands to the lower ribcage] try and push my hands out by breathing into the sides of your ribs. Now let your breath out through your mouth. Now take a deep breath into your upper chest [placing hand on breastbone]. Good, now let that go. Now we're going to combine the three in the order we just did. Try and do them slowly. Ready? [touch stomach] Into the stomach, [touch ribs] ribs, [upper chest] and chest, and now out. Good. If you find yourself getting stressed, try doing this to help you relax.
I'm going to begin the massage with your upper chest to increase the blood flow to your arm and neck. From there I'll work on the shoulder that's bothering you, then the arm, and then I'll finish up today with the neck. Is that OK?
Is it painful for me to massage the shoulder and arm on the right? No? Great. [While massaging the upper chest and the arm] I understand that you're having a muscle spasm in your shoulder. This is most likely caused by your deltoid. I would like to do a technique with you that should help reduce the spasm. It is called the "Origin and Insertion" technique. The way it works is that when your muscle is being used, it has receptors that tell it to relax. This technique stimulates those receptors so that it will relax, making the spasm relax too. I will be using a my thumb to make Xs over the origin and insertion of the muscle to do this. I will use a moderate pressure, but if you find it is too deep, please let me know and I will do it more gently. Is this OK with you? Do you understand? [perform technique]
[Massage upper arm some more] I also see that you are having some spasming and tightening in your biceps. I can perform a stretch that will help with that. It is called 'Agonist Contract'. It should cause more pain, so if it does, let me know. And please keep breathing normally throughout. If you could please shift over so your arm and shoulder are off the table, thanks. You can hold on to the other side if it makes you feel more secure. I'm going to gently take the muscle into what is called the first barrier of stretch. [do so while stabilizing at shoulder] Now that I'm here, when I say GO, I'm going to ask you on your next breath in to try and bring your arm back like you're trying to bowl. I'm going to prevent you from doing it and we're going to hold that for 10 seconds. OK? Go. [isometric stretch 10 seconds] And on your next exhale, relax. Great. I'm going to take it a little further now until I feel more resistance. There. And on your next inhale, please try to "bowl" again while I resist. Go. [10 seconds] And relax. You're doing great. I'm going to bring it back a little further. And please "bowl" one more time. [10 seconds] Keep breathing normally, you're doing great. And relax. And now I'm going to take it into the full stretch that I can and we'll hold it there for 30 seconds. Here we are. [15 seconds for OP purposes, then gently return arm to resting position and perform effleurage]
Now I'm going to work on your neck. [While massaging] You've said that you're feeling headache-like pain across the side of your head, right? This is often caused by a "trigger point" in a muscle group called the sub-occipitals. A trigger point is a little bit like a muscle spasm, except that it only happens in a few fibers of a muscle and causes a "taut band". We treat them by placing pressure directly on the most tender point and holding it for 30 seconds to 2 minutes or until the muscle releases. This can sometimes cause immediate pain, but that shouldn't go above a 7 out of ten. The pain scale goes from 1, which is no pain at all, to 10, the worst pain you've ever felt. I can feel a tender nodule right here. Does it recreate that pain you described when I press on it? Yes? OK. Now that I've explained the therapy to you, do you want to go ahead and have it treated? Great. So I want you to keep talking to me. Is this the most sensitive spot? Yes? When I press on it, where is your pain at? A 7. OK. Take a deep breath in for me. And out. Is the pain level going down as I hold it? Yes? Where is it now? A 5. OK, we'll keep going. A 3 now. Great. We're almost done. And a 1... there, I felt it release. OK, we're going to do a flushing of the muscle [massage] and a stretch to help release the trigger point. I'm going to press down on your forehead - please glance at your toes for me. Perfect, and we'll hold this for 30 seconds. [15 for the OP]
[While massaging neck more] When you get home tonight, try and place a hot pack on your neck, or warm moist heat - like a hot shower on your neck. Try to make sure your glasses are adjusted properly and not to look up at too many things. Maybe look at your computer set-up and make sure the monitor is at the proper level for you, and try not to overuse your arm for the rest of the day. OK? Have a great day, Simon.
[and fin]
