Sport massage therapy

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Sport massage therapy
2014-01-26 09:46:59
Sport massage injury
this is from college book,study tool
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  1. Benefits of sports massage
    • When injured tissue is
    • massaged it heals with less scaring.
    • The repair of tissue that
    • is massaged is 5-7 times faster than tissue that is not massaged.
    • The pain can be reduced
    • with massage.
    • Function of the injured
    • area can be regained faster with massage
    • Massage can help maintain
    • the full range of movement of the injured area.
    • Massage can help the
    • client to remain more psychologically positive.
    • Sports massage does not
    • just have to be saved for the treatment of injuries that have already
    • occurred ,it is much more powerful used as a preventative tool to keep the
    • body healthy
    • An injury that is treated
    • with sports massage techniques will have a lesser risk of reoccurrence
    • than one left to heal itself.
    • The athletes fitness
    • capabilities will be increased due to massage can with recovery time, improve
    • flexibility, etc. Increase ROM.
    • Post event massage helps
    • clear out waste and toxins e.g. lactic acids from the muscles, reducing
    • stiffness and enabling a faster recovery than post –event rest.

    • Scar tissue
    • Fibrous adhesion
    • Forms after a tear in the tissues
    • Formed as a result of excess tension in the tissue-may not
    • be any tearing
    • New tissue forms with larger amount of collagen
    • Formed from existing muscle tissue that knots and tangles
    • lts in areas of extreme tension and lack of
    • flexibility
    • Results in general increase in tension in tissue
  2. Sports massage movements and techniques


    • Standard effleurage is done with the flat of a relaxed hand.
    • It is a relaxing stroke always done at the beginning and end of the massage. It
    • can also be used to connect different strokes to maintain rhythm. It warm the
    • skin, prepares the area for deeper work, spreads the massage medium and helps
    • to eliminate toxins.

    • Sports massage effleurage is very similar to effleurage used
    • in others forms of massage. However, in addition to traditional effleurage,
    • which is performed using the palms, it may involve the use of the lower arm to
    • apply deeper pressure strokes over larger areas.



    • Petrissage is a compression stroke, such as kneading, which
    • squashes the muscle tissue against itself and the underlying bone. This helps
    • to break down tension in large muscles and is not used directly over bony areas
    • due to the risk of bruising. It help to improve the elasticity of the muscles,
    • decreases muscle tension and aids relaxation and circulation.



    •  Compression as the
    • name suggest, result in the muscle being compressed against the deeper tissues
    • and bone. This results in an improvement in circulation and removal of lactic
    • acid and other wastes from the muscle tissue. The therapist begins by pressing
    • at the insertion of the muscle and moves along to its origin.



    • A very deep technique, heavily stimulating on the blood
    • supply. Good for adhesions and scar tissue in the muscles and loosens and realigns
    • tangled muscle fibers. Beneficial at muscle attachments and around joints. The
    • digits or elbows can be used, and care must be taken not to crush the tissues
    • against the underlying bone as this can cause bruising and damage to the tissues.
    • The pressure must stay within the pain threshold and the movement should not be
    • performed for too long at the time, it is better to move off the area and
    • return to it later.

    • There are three different types of frictions that will be
    • studied in detail.

    • Circular frictions used
    • around joints.
    • (Longitudinal)Normal
    • frictions used on tense muscles
    • Cross fiber frictions used
    • on used on tense muscles or ligaments that are weak
    • All frictions help to
    • increase heat in the area, increase circulation and lymphatic drainage to
    • the region, stimulates the nerves and loosens areas of tension and scar
    • tissue.




    • Percussion strokes include hacking, cupping, beating,
    • pounding and the smaller fingertip

    • Movements of Tapotement. 
    • These are invigorating strokes which will stimulate a muscle and are
    • used primarily over weakened atrophied muscles. In a relaxation massage they
    • can be used before the final effleurage to help wake up the client. They all
    • result in increased circulation, warming of the skin and the muscles, increased
    • muscle tone and invigoration of the nerves


    • The aim of vibrations are to shake the muscle fibers to help
    • with relaxation and to loosen tension .Used on the quadriceps and calves
    • mainly.

    Neuromuscular technique – NMT


    • A technique where the digit is held in the one place over a
    • sore point and the pressure increased to the clients pain threshold limit. This
    • provokes a reflex in the nervous system, which helps the muscles to relax and
    • reduces spasm and pain.

    Strain –Counterstain


    • This can be used alone or in conjunction with NMT to relieve
    • tightness and pain in the muscle or tendon injuries. It involves moving the
    • muscles into a more relaxed position while performing a neuromuscular technique
    • to aid in relaxation.

    Connective Tissue Manipulation-CTM


    • A form of stretching that involves movements which help to
    • loosen adhesions, fluid and fibrous accumulations, outside of thigh-lower back
    • are typical area, between the muscle fascia and the subcutaneous layer.

    Soft Tissue Release-STR


    •  Technique that
    • improves flexibility in a localized areas of muscle or tendon. It involves a
    • combination of pressure and movement which causes the muscles to lengthen and
    • stretch.


    Muscle Energy Technique-MET


    • Very effective movement in increasing overall flexibility
    • and decreasing muscle tension. It involves using restricted or resistive
    • movements to stretch muscles. This inhibits the muscle spindles and Golgi
    • tendon organs to allow an improvement in flexibility.
  3. Neuro-muscular Technique (NMT)
    • 1.     
    • Warm the area with either – Effleurage and
    • petrissage. Massage and heat treatment.

    • 2.     
    • Using either the thumbs, elbow or fists, locate
    • the most tender spots in the muscle.

    • 3.     
    • When on the tender spots gradually increase the
    • pressure into the area.

    • 4.     
    • Tell your client to use a scale of 0-5 for the
    • pain,5 meaning the pain is too much to bear,4 is maximum tolerate,0- being no
    • pain only pressure can be felt. The treatment should work within the pain
    • tolerance of the client at all times.

    • 5.     
    • As this is an uncomfortable form of treatment
    • explain to the client that they need to help you by doing three things

    -To relax the area completely

    • - To focus all their attention
    • on the area

    - To take deep breaths.

    • 6.   Tell the
    • client to tell you when the pain in easing using the scale above. 6. Seconds is
    • a good average time to apply pressure, with an absolute maximum of 9 seconds. If
    • the pain does not ease after 90 seconds and the client is relaxed and breathing,
    • there could be an underlying complication or the injury may be more serious
    • than originally thought.

    • 7.   One area can be returned to up to three
    • times in a session, any more than that may aggravate the area.

    • 8.     After the NMT you will need to perform a
    • stretching movement on the muscle to further restore a health tone. This can be
    • done by manually stretching the muscle or by performing a massage stroke that
    • has a stretching effect i.e. stripping/deep effleurage.

    • 9.   Always finish with effleurage towards the
    • nearest lymph node.

    Physiological benefits of NMT.

    • This techniques should inhibit the neural
    • message from the muscle to the brain, which should bring about pain relief
    • and relaxation.
    • Def.- It provokes a reflex in the nervous system
    • that aids in muscle relaxation.-
    • Reduces the protective muscle spasm that has
    • developed in the muscle as a result of the injury.
    • Temporarily compress the blood vessels supplying
    • the injured tissue, so that when the pressure is released, the blood
    • floods the area causing an extreme change that induces relaxation in the
    • area.
    • Stimulates the nervous system to suppress the
    • body’s normal reflex reaction of contracting injured muscles.
    • Stimulates the release of endorphins, the body’s
    • natural pain killers.
    • Caution.

    • Applying too much pressure,
    • applying the pressure too fast or coming off the area too quickly, can result
    • in the muscle tone increasing further to the point of spasm.
  4. Frictions
    • A very deep technique, heavily stimulating on the blood
    • supply. Good for adhesions and scar tissue in the muscles and loosens and realigns
    • tangled muscle fibres. Beneficial at muscle attachments and around joints

    • The digit or elbows can be used. Frictions should never be
    • used on acute problems and should not crush the muscle into the bones, as this
    • can bruise the tissues. The pressure must stay within the pain threshold, and
    • the movement should not be performed for too long at one time, better to move
    • off the area and return to it later. Always follow with stretching movements.

    Circular Frictions


    • Used mainly around the joints to loosen shrunken and stiff
    • fibrous capsules. Good after an injury in which the joints has been immobilised
    • for a period of time. In this case the fibrous capsule will have formed fibrous
    • adhesions that will limit the movement of joint leaving it open to injury. Also
    • good where stiffness muscle has limited joint range of movement

    Parallel Friction


    • Friction that is applied working with the direction of the
    • muscle fibres.
    • This stroke will break down fibrous adhesions and scar tissue while also
    • lengthening the muscle.
    • Good on muscles that have become too shot, example, upper trapezius due to
    • overuse or any muscle after an injury.

    Transverse friction or Cross fibre friction


    • Friction that is applied working against the direction of
    • the muscle or ligament fibres.
    • This stroke will also break down fibrous adhesions and scar tissue while also shortening and strengthening the muscle/ligament.
    • Good on muscles that are too long and too weak: example middle trapezius.
    • This stroke is also extensively used on ligaments
    • that have been injured as these structures always heal too long and suffer from
    • less strength that before.
  5. Inflammation
    • Damage to the body’s tissue triggers a response called
    • inflammation. This can be caused by pressure, friction, repeated load and
    • external trauma. Tissue injuries damage tissue cells and blood vessels causing
    • fluids to leak into the spaces between the cells, which causes inflammation.

    Symptoms of inflammation

    • Pain
    • Swelling
    • Redness
    • Heat
    • Loss of function, depending
    • on the site and extent of damage

    • When muscles, tendons or
    • ligaments are damaged, blood vessels in the area are torn. As a result bleeding
    • occurs and spreads rapidly into adjacent tissues. This bleeding causes swelling
    • which in turn results in increased pressure on surrounding tissues, which
    • become tense and tender.

    • In the early stages this is the
    • body’s attempt to stop the bleeding, as increased pressure in the surrounding
    • tissues increases the pressure on the damaged blood vessels, which does slow down
    • the blood loss. However, over time the increased pressure causes pain in
    • sensitive tissue by pressing on nerves. This pressure also restricts blood flow
    • to the area, which impairs the healing process and causes a build-up of waste
    • products. Therefore, repair of the damaged tissue begins in the active phase of
    • inflammation by limiting blood loss but cannot be completed until all harmful
    • substances have been removed from the site of the injury.

    • If this cycle of events can be interrupted,
    • healing is enhanced. So in cases of soft tissue injury, it is important to
    • inhibit and control bleeding as soon as possible. Treatment should be started
    • immediately. If carried out correctly it can greatly reduce recovery time for
    • an injury.

    • If inflammation is left
    • unchecked, congealed blood will remain in the area will be converted to scar
    • tissue and for this reason early intensive treatment is recommended. For tissue
    • to heal it is important that the body produces new tissue to repair the area. The
    • new bundles of fibres made mainly from collagen re-unite the broken fibres but
    • not with the same uniform pattern as the rest of the tissue. Instead the fibres
    • have a very haphazard fashion and tend to be less flexible and more rigid that
    • rest of the structure. For the injury to heal as well as possible the initial
    • inflammation process needs limiting with the P.R.I.C.E. principle, the new scar
    • tissue fibres need gentle but repeated stretching into place, something massage
    • is very good for.

    Average tissue healing rates


    • Muscle is more prone to injury
    • but heals faster than other types of tissue, usually between 2-3 weeks.

    • Tendons and ligaments are less
    • prone to injury but are much slower to heal than muscle usually about 8 weeks,
    • with ligaments sometimes taking longer.
  6. The P.R.I.C.E. Principle
    • The price principle is applied to injuries in the acute
    • phase of an injury, i.e. usually the first 48-72 hours when inflammation and
    • bleeding is occurring. It is necessary to promote healthy healing of the
    • tissue.

    • P      Protection.                   Protect the area from further
    • damage
    • R      Rest.                              Rest the injured
    • area from exercise and other day activities that could
    • aggravate it. Active movements that do not cause pain are beneficial.

    • I        Ice.                                To restrict
    • blood flow and limit pain

    • C       Compression.              Restrict blood flow, limit
    • swelling.

    • E       Elevation.                      To enhance lymphatic
    • drainage and removal of waste products,
    • by aiding in venous blood flow.
    • This elevation also slows the arterial blood flow to the area and
    •                                                   therefore can help in restricting the amount
    • of bleeding.

    Acute phase 1-3 days (24-72h)

    • Post-Acute phase -3-4 days massage,
    • stretching

    • Remodelling phase – Full ROM, Pain free.
    • Straight, training.
  7. Assessing the soft Tissues
    How do I find where the problems are and what to treat?

    •  For
    • the first massage Treatment, the therapist will need to palpate (feel) the
    • clients muscles to look for problems areas, lumpiness, tightness and adhesions.
    • Any pain felt in an indicator of injury or damage to muscle. Tightness or lumpiness
    • indicates tension or that the muscle has not healed properly after a previous injury.
    • Palpation generally reveals problem areas in superficial muscles; deep muscles
    • may be inaccessible.


    What is palpation?


    • Palpation is the method used to assess muscles and/or the
    • degree of swelling or damage. Very simply it is the process of using the hands
    • to touch the different muscles and parts of the body in order to determinate
    • their condition. To process is two-way- as the therapist touches the different
    • areas of the body the client needs to explain whether there is any pain or
    • discomfort in the areas of the body the client needs to explain whether there
    • is any pain or discomfort in the various muscles, so that the therapist can
    • assess the muscle in terms of both how it feels to the touch and how the client
    • feels when it is touched. When working on deeper muscles where the damage may
    • be hard to palpate, the non-working hand should be used for support because
    • sometimes a reflex action in a muscle other than the one being palpated can
    • suggest a problem. Tension in superficial muscle may also be caused by a
    • problem in deeper layer of muscle.

    • Palpation should be carried out slowly, to ensure that the
    • assessment is thorough. The pressure should be light at the start then
    • gradually increased to prevent any muscle tension developing or causing
    • unnecessary discomfort to the client. This is especially important in areas
    • that are obviously inflamed or that the client has reported as a problem.
    • Through the palpation, the therapist should pay attention to all client
    • feedback, both verbal and physical.

    • Experience, gives massage therapist the ability to distinguish
    • between the various kinds of soft tissue according to how they feel. When
    • relaxed and in good condition muscle should feel soft, smooth and pliable,
    • without lumps, tightness or knots. It should be easy to move and should not
    • hurt. Tendons, being fibrous extension of the muscles fascia, feel firmer and
    • stringier, but should not be rigid or stiff. Where there is specialized
    • thickening of fascia, such as the Iliotibial band and the thoracolumbar fascia
    • (lumbar spine) tissue will also feel firmer and less resilient.

    • If they are not rehabilitated sufficiently after trauma, the
    • condition of the body’s natural splinting system minimizes further damage. Fibrous
    • tissue is vital to bind the area initially, but in the event of chronic tension,
    • healing is impaired by curtailed circulation. The fibrous tissue does not
    • process the characteristics of the tissue it has replaced so it remains, binding
    • and gluing the area. The tension consisting of shortened less efficient fibers,
    • also remains. Efficient muscular skeletal functioning cannot be resumed and
    • over –use injury develops as postural adaptation occurs.

    • General variations will occur with age, sex, fitness,
    • occupation and previous injury. However, poor texture can be identified and
    • categorized under the following headings:
  8. 1.  
    Tension and Hyper tonicity
    • The tissue are generally
    • shortened and tense. They feel resistant and lack pliability and will be
    • difficult to move and not very flexible.

    • 1.  
    • Adhesions


    • Following injury and inflammation, tissue-making cell called
    • fibroblast rush to the area and start mending the damage with collagen fibers. In
    • some instances, especially if to the injury remained tense after the injury or
    • healing was not completed properly, the new tissue does not receive enough
    • oxygen and nutrients and becomes sticky and inflexible and the muscles fibers
    • stick together. In some instances, especially if the injury remained tense
    • after the injury or healing was not completed properly, the new tissue does not
    • receive enough oxygen and nutrients and becomes sticky and inflexible and the
    • muscles fibers stick together. In some instances fibers develops between the
    • different muscle fascia’s sticking them together. As a result the muscles will
    • not be as efficient, other local muscles, bones and joints will adjust and overwork
    • to compensate for the weakness of the damaged area and the problem, instead of
    • being treated becomes part of the body’s structure. And the formation of
    • fibrous tissue, adhesion of fascia can occur, these re usually longitudinal
    • bands of tension. They feel woody and stringy and may “flick” if being palpated
    • across their fibers.

    • Adhesion can also be palpated in tense, shortened, overused
    • muscles. These feel like knots and lumps, which will gradually break from one
    • big lump, into several smaller lumps until eventually a gritty feeling is felt.

    • 2.  
    • Scar Tissue


    • Inflammation and damage to tissue can result in the
    • formation of a collagenous scar. Scar tissue is localized and lacks mobility,
    • flexibility and strength. It can feel like marbles and is usually hard and solid.
    • The older the scar tissue the more rigid it will be.

    • 3.  
    • Oedema and swelling


    • Oedema and swelling are caused by an excess of tissue fluid
    • following injury, due to capillary damage. The area can feel spongy and squishy.
    • The lymph fluid is the body’s protection for a damaged area, allowing it to
    • concentrate on sorting out the problem. Swelling can be detected by pressing
    • with a finger on an area that appears swollen, if the finger leaves a white
    • mark in the area oedema is present. Also the affected area will feel watery and
    • full of fluid. Extremely swollen areas will be firmer, even solid, and
    • relatively immobile and painful due to the excess fluid pressure on the sensory
    • nerves.


    • 4.  
    • Painful areas


    • Try and work out if pain is caused by any of the above. If not,
    • and the client is unaware of the problem and has no reason for the pain, refer
    • them to GP before continuing treatment.

    • 5.  
    • Fatty nodules


    • These occur close to the skin’s surface and feel lumpy to
    • touch.

    • 6.  
    • Inflammation


    • Look
    • for redness, heat and pain and swelling. Do not treat with massage if these are
    • evident
  9. Common Causes of sport injuries
    • The causes of sports injuries can be divided into two
    • sections:


    Extrinsic/ Environmental injury


    • External forces cause
    • injury to the body e.g. fall kick, blow from a heavy object, poor training
    • surfaces, cold training conditions.


    Intrinsic/Personal injury


    • Internal forces cause
    • injury to the body e.g. Muscle pull. This type of injury may be through the
    • personal pushing themselves too hard or incorrect training.



    Extrinsic/ Environmental injury

    •  Extrinsic
    • and environmental injuries result from outside elements, some of which are
    • under the control of the athlete, some are not.


    External trauma

    • These injuries are caused by an
    • external force. Another player falls and their knee impact your quadriceps
    • causing injury due to squashing of your quadriceps muscle against the
    • underlying femur. Or a player tackles you incorrectly and pulls your foot out
    • from under you.  This can result in
    • injury your hamstrings is being over stretched.


    Type of sport

    • Certain sports, due to their
    • physical nature will result in more injuries. Rugby for example, can cause
    • serious extrinsic injuries, due to the amount of tackling involved that can
    • result in the body weight of one player impacting onto another player.

    Training errors

    • Incorrect training techniques
    • will always guarantee an injury. Failing to perform a warm-up and cool-down
    • will result in poor flexibility and cause a muscle tear. No lifting a weight
    • through its full range of motion, will result in different amounts of strength
    • in a muscle and this will cause injury.




    • Environmental factors can result
    • in injury. When athletes train in cold weather, they must allow extra time in
    • the warm –up to ensure that the body has reached a suitable temperature that
    • increases blood flow to the muscles. Athletes who perform the same warm-up
    • regardless of whether condition, risk injury due to cold inflexible muscles.

    • Cold weather also results in hard
    • compacted ground for athletes who train on outdoor surfaces. This limits the
    • shock absorption capabilities of the surface and cause injury, especially to
    • the lower leg.

    • Similarly, training in hot humid
    • climates can cause injury due to heat stroke/ heat exhaustion and dehydration.

    • Environment factors can also
    • cover “Ugly Parent Syndrome”! Parental interference and pressure are one of the
    • main reason why children drop out of sport. Too much pressure to perform and
    • excel at a sport, either from a parent or from an overzealous coach, will
    • result in injury to the athlete, not to mention mental stress and zero enjoyment
    • in their sport.

    Poor Equipment

    • Training with old or faulty
    • equipment can result in serious injury. Should a cable snap on a weights
    • machine or a barbell snap during a heavy lift, this can result in potentially
    • life threatening injuries to the athlete. Training with incorrect clothing
    • especially worn out footwear, will result in injury to the lower leg and foot,
    • due to lack of shock absorption and lack of support to the foot.
  10. Intrinsic/Personal injury
    • Intrinsic injuries are the more common of two injuries.
    • These are injuries which occur with no outside influences.

    Overuse injury.

    • The most common of all sports injuries is the overuse
    • injury. It can develop slowly over a period of time ranging from days to weeks,
    • months or even years. In many cases the sports person may not be aware of the
    • problem until it reaches a critical level and injury occurs.

    • Overuse injuries are generally caused by overload or
    • repeated microscopic injuries to the muscular system. Some examples of causes
    • of overuse injuries are muscle imbalance, training errors, faulty techniques
    • (often seen in beginners), training on incorrect surface etc.

    Unaccustomed use.

    • Working strong muscle in a different way can cause injury.
    • For example, a cyclist who normally trains by cycling 10 miles a day, decides
    • to run 10 miles. This cyclist could easily cause an injury due to the different
    • strains and pressures being placed on the muscles, as a result of performing a
    • different form of exercise on a different training surface.

    Insufficient Warm-up/Cool-down


    • This is a commonly neglected area, which can result in injury.
    • The particular tissue involved in activity must be prepared for the stress that
    • they are about to experience. If cold and tight muscles are suddenly expected
    • to expend hard effort, they will be vulnerable to damage .Whereas, if a warm
    • –up is done, then the blood circulation to the muscles is increased. This will
    • result in the muscle becoming warmer and they will have a larger degree of flexibility,
    • allowing them to take the strains placed on them by exercise without tearing.

    • A sufficient cool-down is also essential as it helps to
    • facilitate the removal of accumulated lactic acid, which if it remains in the
    • muscles will cause tension, pain and stiffness, which in turn increase the risk
    • of injury.

    • Stretching is also an important part of cool-down, as it
    • helps to realign muscle fibers, aids in the removal of lactic acid and
    • therefore helps to prevent stiffness.

    -Faulty Biomechanics

    • -Age
    •  Inflexible muscles                                                                                                   Flexible
    • muscles
  11. Fatigue or over training
    • Repeated performance of a particular exercise can overly
    • fatigue the muscles, which will leave them open to injury. This can easily
    • happen, especially in competition, when the athletes push themselves to the
    • limit, which is often seen at the end of match or training session. This can
    • result in a muscle being asked to do more than it is able to, resulting in
    • injury.

    • Similarly, problems can arise if training session are too
    • frequent, with insufficient time for the tissues to recover fully between each one.



    • Age effects the strength and resilience of the tissues.
    • Muscular strength begins to decline at the relatively early age of 30-40 years.
    • The elasticity in tendons and ligaments decreases from the age of 30 and the
    • strength of bone decreases after the age of 50.

    • Inactivity accelerates the natural degeneration of muscles,
    • tendons, ligaments and bone, while activity delays it.

    • Age can also play a role in injury, where mental maturity,
    • or the lack of it, can cause injuries. This can be seen in teenage athletes who
    • train excessively or incorrectly in a bid to bulk up/lose weight as fast as possible.
    • They will use short cuts, commercial gadgets, dangerous supplements, and often
    • poor training techniques to achieve their goal as quickly as possible.

    Health problems


    • For
    • example, infections, cold, flu, high temperatures etc.
    • These conditions increase the risk of complications such as inflammations of
    • the cardiac muscle. The risk of the infection being spread throughout the body
    • is increased, while the body’s ability to fight the disease is decreased as
    • energy needed to combat the infection is being spent on exercise
  12. Contraindications
    • Never treat unless the injury has been diagnosed and
    • treatment has been recommended by a medical practitioner.

    • Ø 
    • Pregnancy

    • Ø 
    • Cardiovascular conditions (thrombosis,
    • phlebitis, hypertension, hypotension, heart conditions)

    • Ø 
    • Hemophilia

    • Ø 
    • Any conditions already being treated by GP or
    • another health professional, e.g. Physiotherapist, Osteopath, Chiropractor,
    • Coach

    • Ø 
    • Medical oedema

    • Ø 
    • Osteoporosis

    • Ø 
    • Arthritis

    • Ø 
    • Nervous/Psychotic conditions

    • Ø 
    • Epilepsy

    • Ø 
    • Recent operations

    • Ø 
    • Diabetes

    • Ø 
    • Asthma

    • Ø 
    • Any dysfunction of the nervous system (e.g. Muscular
    • sclerosis, Parkinson disease, Motor neuro disease)

    • Ø 
    • Bells palsy

    • Ø 
    • Trapped pinched nerve(e.g. Sciatica)

    • Ø 
    • Inflamed nerve

    • Ø 
    • Cancer

    • Ø 
    • Postural deformities

    • Ø 
    • Spastic conditions

    • Ø 
    • Kidney infections

    • Ø 
    • Whiplash

    • Ø 
    • Slipped disc

    • Ø 
    • Undiagnosed pain

    • Ø 
    • When taking prescribed medication

    • Acute
    • rheumatism
  13. Contraindications
    that restrict treatment
    • Ø 
    • Fever

    • Ø 
    • Contagious or infectious diseases

    • Ø 
    • Under the influence of recreational drugs or
    • alcohol

    • Ø 
    • Diarrhea and vomiting

    • Ø 
    • Skin diseases

    • Ø 
    • Undiagnosed lumps or bumps

    • Ø 
    • Localized swelling

    • Ø 
    • Inflammation

    • Ø 
    • Varicose veins

    • Ø 
    • Pregnancy(abdomen)

    • Ø 
    • Cuts

    • Ø 
    • Bruises

    • Ø 
    • Abrasions

    • Ø 
    • Scar tissue(2 years for major operation and 6
    • months for a small scar)

    • Ø 
    • Sunburn

    • Ø 
    • Hormonal implants

    • Ø 
    • Abdomen(first few days of menstruation depending
    • on how the client feels)

    • Ø 
    • Hematoma

    • Ø 
    • Hernia

    • Ø 
    • Recent fractures(minimum 3 months)

    • Ø 
    • Cervical spondylitis

    • Ø 
    • Gastric ulcers

    • Ø  After
    • a heavy meal.