Structural Massage (05:21)
Sean Riehl believes testing, working and retesting is the mantra of structural massage. He applies specific techniques to each joint. One of those techniques is static pressure with passive motion.
ROM Evaluation (05:10)
One of the pillars of a structural massage is to do a postural range of motion evaluation at the beginning of each session. This exam is done regardless of what kind of injury the client has.
Shoulder Evaluation (07:43)
If a shoulder is too high or too low make an assessment. Have the client stand normally with their hands at their side. This treatment is going to revolve around whatever shoulder is forward.
The Neck: Rotation and Lateral Flexion (11:00)
When evaluating your client's neck, they need to face you. Then, have them rotate to the right and left, noticing how far they can go from side to side. Move through the full range.
The Neck: Anterior, Medius, and Posterior (08:56)
The lower neck side bending is controlled by the three scalene muscles. The upper neck side bending is controlled by the suboccipital muscle group.
Upper Neck Restriction (08:28)
For increased pain during a session, use opposite contraction or static pressure with shortened muscle. For upper neck restriction, take the client's head in your hands, and do a little jog from right to left and notice how the chin moves.
External Rotation (06:24)
The muscles that perform shoulder external rotation are the infraspinatus, teres minor, and the posterior deltoid. Work these muscles if there is pain during a strength test.
The Shoulder: Internal Rotation (10:01)
The muscles that resist internal rotation are the infraspinatus, teres minor, and posterior deltoid. Work these muscles if there is restriction on internal rotation.
Cross Fiber Friction Infraspinatus Tendon (02:38)
If you performed a strength test for the external rotators and the client experienced pain, then focus on the infraspinatus tendon. Move inferior to the acromion process.
Shoulder: Abduction (08:17)
The muscles that perform shoulder movement are the supraspinatus and lateral deltoid. During the evaluation phase, if there is tenderness this indicates issues with the muscles that move the glenohumeral joint.
Cross Fiber Friction Supraspinatus Tendon (02:04)
Find the acromion where the supraspinatus tendon comes out. Then internally rotate it and friction lateral to medial.
Shoulder: Protraction & Depression (08:45)
The main muscle that brings the shoulder forward and bends it downward is the pectoralis minor. Perform the evaluation for protraction and depression while standing.
Shoulder: Protraction & Elevation (09:39)
The serratus anterior muscle brings the shoulder superior. The levator scapula and upper trapezius muscles can also be involved in shoulder abduction.
The Elbow: Flexion and Extension (07:28)
Everybody can straighten and extend their elbow joints, but sometimes have a little restriction inflection. Restriction can be caused by tension in the triceps.
Elbow: Flexion (04:42)
One of the muscles that controls elbow flexion is the brachioradialis. The muscles that restrict elbow flexion are the triceps and the anconeus.
The Wrist: Flexion, Extension, Pronation, Supination, Thumb Flexor
Range of motion for wrist flexion testing is performed while standing. Notice if there is a difference between the right and left wrists. Feel for springy quality at the end of the exam.
Wrist: Extension (07:40)
The therapist should focus on are the extensor carpi radialis longus, extensor carpi radialis brevis, extensor carpi ulnaris, and extensor digitorum muscles. Flexor digitorum muscles move the fingers.
Wrist: Limited Flexion (06:26)
If the client has weakness or pain when motion tests are performed, then the muscles to focus on are the flexor muscles. The client can be on the table when performing evaluations for these tests.
Wrist: Limited Supination (05:49)
During a range of motion examination, if the client has weakness or pain, focus treatment on the pronator muscle group. Supinate the client while on the table face up.
Wrist: Pronation (06:33)
Pronate each side of the wrist and notice if one side is more restricted than the other. Both sides should look and feel the same. The supinator muscle will be tight if there is restriction.
Thumb Flexors (02:44)
Sore thumb muscles can mimic wrist pain. The pollicis longus muscle attaches to the tip of the thumb and goes all the way up the wrist approximately halfway to the elbow.
To evaluate the rib cage notice the client's rotation from side to side. Have the client sit on the edge of the table and place their hands on their chest for the examination.
Back Tests (10:30)
Start the evaluation for the back by having the client in a standing position. Next have the client sit on the massage table and cross their hands over their chest and bend side to side.
Back Technique (02:31)
If the ilium on the left hand side is stuck and the pelvis is high, it is important to pull it down. In order to do this, grab the ankle and leg then pull.
Hip: Internal Rotation (06:37)
The muscles that internally rotate the hip are the gluteus medius, gluteus minimus, and tensor fascia lata. Work on the muscles that resist internal rotation if the client has limited rotation.
Hip: External Rotation (05:19)
The gluteus medius and tensor fascia lata muscles limit external rotation. To work on these muscles, first start with static pressure massage. Then with your thumbs find the crest of the ilium and move down.
Lumbar: Extension (06:14)
Tight erector muscles are the most common source of back pain. Use the forearm stroke to release these constricted muscles. Riehl likes to use Santa Barbara massage cream because it is chemical free.
Lumbar: Sidebending (07:50)
To work on the quadratus lumborum muscle, have the client lay on the massage table on their side, then have the top leg straight out and the bottom leg bent. Use a bolster to support the head.
Hip: Flexion (07:16)
The muscles that primarily perform hip movement are the psoas, iliacus and rectus femoris. If someone has back pain it could limit hip extension and refer pain all the way down to the lower back.
Knee: Flexion (11:23)
The muscles that flex the knee include the hamstrings along with the gastrocnemius. Work these muscles if there is pain during the flexion range of motion testing.
Knee: Extension (09:08)
The muscles that extend the knee include the vastus medialis, vastus lateralis, vastus intermedius, and rectus femoris. The muscles that limit extension are the semimembranosus, semitendinosus, biceps femoris, and the gastrocnemius.
Knee: Applying Static Pressure (05:38)
Apply pressure downward with the thumb after you have found the tendon. If there is a pulsing or if the person's leg starts to go numb stop applying pressure in that area and move to another area.
The Ankle: Dorsi Flexion, Plantar Flexion, Supination, Pronation, Ligaments, Tendons (05:10)
When working on the ankle, pain usually indicates a sprain. Another common injury is Achilles tendinitis. Do not work on a recent ankle injury.
Ankle: Plantar Flexion (09:30)
There are six ways to release plantar muscles. First use static pressure on the tibialis anterior located next to the tibia. Then with gentle pressure relax into the muscle and feel for tenderness.
Ankle: Active Resistance (03:20)
Always check your work by testing and retesting. Pause one second in between barriers. You should see a big difference after doing this massage in the range of motion the client has.
Ankle: Dorsi Flexion (08:56)
The muscles that restrict dorsiflexion motion are the soleus and gastrocnemius. To work on these muscles apply static pressure to three different spots on the soleus.
Ankle: Static with Active Motion (04:42)
Apply static pressure with thumbs. To get better pressure, stand up, straighten the elbows and relax the thumbs. Use a forearm as an alternative to using the thumbs.
Ankle: Supination (10:32)
Find the head of the fibula. When applying static pressure do not rely on a specific amount of time, just wait for the tissues to soften. You should be able to feel the muscles moving.
Ankle: Pronation (01:34)
The pronation motion is limited by the tibialis anterior and posterior. The muscles that restrict pronation are the ones a therapist should focus on if the client has limited pronation during the range of motion tests.
Ankle: Ligaments (04:12)
If someone has an ankle sprain and wants deep massage work done, make sure the swelling has gone down and the injury was at least five days ago. Then it is okay to work on the peroneus longus and brevis muscles.
Ankle: Tendons (04:00)
Achilles tendinitis is a common ankle injury. If someone has a restriction in dorsiflexion motion it is important to release the gastrocnemius and the soleus. These muscles may have been tight for a long time.
Credit: Structural Massage (00:02)
Credit: Structural Massage
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