The Muscle and Bone Palpation Manual with Trigger Points, Referral Patterns and Stretching

531 Pages·2009·56.81 MB·English

by  Joseph E. Muscolino DC

MOSBY
ELSEVIER
11830 Westline Industrial Drive
St. Louis, Missouri 63146
THE MUSCLE AND BONE PALPATION MANUAL
WITH TRIGGER POINTS, REFERRAL PATTERNS,
AND STRETCHING ISBN: 978-0-323-05171-2
Copyright 83 2009 by Mosby, Inc., an affiliate of Elsevier Inc.
All rights reserved. No part of this publication may be reproduced or transmitted in any form or by any
means, electronic or mechanical, including photocopying, recording, or any information storage and
retrieval system, without permission in writing from the publisher. Permissions may be sought directly
from Elsevier's Rights Department: phone: ( + 1) 215 239 3804 (US) or ([phone] (UK); fax:
([phone]; e-mail: [email protected]. You may also complete your request on
line via the Elsevier website at http://www.elsevier.com/permissions.
Notice
Neither the Publisher nor the Author assume any responsibility for any loss or injury and/or damage
to persons or property arising out of or related to any use of the material contained in this book. It is
the responsibility of the treating practitioner, relying on independent expertise and knowledge of the
patient, to determine the best treatment and method of application for the patient.
The Publisher
Library of Congress Cataloging-in-Publication Data
Muscolino, loseph E.
The muscle and bone palpation manual with trigger points, referral patterns, and stretching / loseph
E. Muscolino. - 1st ed.
p.; cm.
Includes index.
ISBN 978-0-323-05171-2 (pbk. : alk. paper) 1. Palpation. 2. Massage therapy. I. Title.
|DN1,M: 1. Palpation. 2. Muscle Stretching Exercises. 3. Musculoskeletal System-physiology. WB 275
M985m 2009|
RC76.5.M87 2009
615.8'22-dc22 2008042526
Vice President and Publisher: Linda Duncan
Senior Editor: Kellie White
Senior Developmental Editor: lennifer Watrous
Editorial Assistant: April Falast
Publishing Services Manager: Julie Eddy
Senior Project Manager: Laura Loveall
Designer: lulia Dummitt
Printed in China
Working together to grow
libraries in developing countries
www.elsevier.com | www.bookaid.org | www.sabre.org
Last digit is the print number: 9 8 7 6 5 4 3 21
D E D I C A T I ON
This book is dedicated to all of my students, past,
present, and future. I have always felt that the class
room and life are about learning and growing. It was
a gift to be a part of your lives as we meandered
through the intricacies as well as the bigger picture
of anatomy, physiology, kinesiology, palpation, and
treatment. So much of my learning took place in the
classroom along with you.
Thank you.
S P E C I AL D E D I C A T I ON
This book is lovingly dedicated to Diane C. Schwartz.
Her courage, spirit, and passion for life, learning,
and love have always been and always will be an
inspiration to me, and everyone's life she touched.
CONTRIBUTORS A ND DVD PRESENTERS
Sandra K. Anderson, BA, NCTMB tinues on JBMT's advisory board. She has co-authored three
Sandra has a BA in biology from NMT textbooks and has written numerous articles on chronic
Ithaca College in Ithaca, New pain management for both magazines and journals. Her pro
York, and has been a professional fessional focus aims to advance education in all health care
bodyworker since 1992, with professions to include myofascial therapies in the treatment of
certification in massage therapy, patients with acute and chronic pain.
Shiatsu, and Thai massage. She
taught at Cortiva-Desert Institute of Neal Delaporta, NCTMB, Chair-Elect for
the Healing Arts in Tucson, Arizona, National Certification
for twelve years, in subjects ranging Board for Therapeutic
from anatomy and physiology Massage & Bodywork
to Shiatsu, and was Director of An honors graduate of the Na
Education for one year. Sandra is tional Holistic Institute in Califor
co-owner of Tucson Touch Therapies, a massage and bodywork nia, Neal passed the NCE in 2000
treatment center located in Tucson. She maintains a private and established a private practice
clientele and also presents workshops on Asian bodywork that includes sports, rehabilitative
techniques. Additionally, she is author of The Practice of Shiatsu and spa modalities, and traditional
(Mosby, 2008). healing practices such as aroma
therapy and ear candling.
Leon Chaitow, ND, DO He has served as a faculty mem
Leon Chaitow is a graduate of ber at the Connecticut Center for
the British College of Osteopathic Massage Therapy and is a member of the American Massage
Medicine. Since 1983, he has been Therapy Association—Connecticut Chapter.
a visiting lecturer at numerous Neal is a prominent speaker, author, and workshop/semi
chiropractic, physiotherapy, osteo nar facilitator, as well as the creator of Top (Therapeutic Opti
pathic, naturopathic schools in mal Performance) Massage: A Sports-Based Protocol Designed
Europe, the United States, Canada, For All Active People.
and Australia. In 1993, Leon was
the first naturopath/osteopath who Mike Dixon, RMT
was appointed as a consultant by the UK government. He is the Mike is a twenty-two year veteran
author/editor of over 70 books, and he is the Founder/Editor- of Massage Therapy. He is an
in-Chief of the peer-reviewed Journal of Bodywork and Movement educator, a published author,
Therapies (Elsevier). After 11 years as Senior Lecturer/Module and an international presenter
Leader in Therapeutic Bodywork and Naturopathy, Leon retired in massage therapy continuing
from the University of Westminster in 2004. In November of education (ArthrokineticTherapy).
2005, he was awarded the Honorary Fellowship by the University He is the senior practical advisor
in recognition of "services to Complementary and Osteopathic for the West Coast College of
medicine." Leon lives and works in London and Corfu, Greece. Massage Therapy (WCCMT).
He is happily married to Alkmini since 1972!
He has developed specialty
courses in continuing education
Judith DeLany, LMT for massage therapist and naturo
Judith DeLany has spent over two paths in the field of orthopedics and rehabilitation therapy
decades developing neuromuscular called "Arthrokinetic Therapy."
therapy techniques in continuing His latest achievement is the release of his new text book
education format for manual Joint Play the Right Way for the Axial Skeleton (2006), which in
therapy practitioners and for volves a multidimensional approach to treating the spine and
massage school curriculum. In pelvis.
addition to instructing NMT He has been teaching at WCCMT since 1993 and has
seminars internationally, she serves taught most courses in the practical department. His specialty
as director of NMT Center in St. is in orthopedics assessment and treatments. Mike also teaches
Petersburg, Florida. at the Boucher Institute of Naturopathic Medicine.
Ms. DeLany served for over a Mike has trained over 2000 massage therapist and naturo
decade as associate editor for the Journal of Bodywork and Move pathic doctors.
ment Therapies (a multidisciplinary Elsevier journal) and con
iv
Contributors and DVD Presenters V
Sandy Fritz, MS, NCTMB Glenn M. Hymel, EdD, LMT
Sandy is the Owner, Director, and Glenn M. Hymel is Professor
Head Educator of the Health En and Chair of the Department of
richment Center, which provides Psychology at Loyola University
education for over 75 massage stu New Orleans. His principal
dents per year. Part of her private areas of specialization include
practice includes working with educational psychology, research
mental health, in conjunction and statistics, and the psychology
with a psychologist who provides of personal adjustment. Dr. Hymel
support care and education for is a graduate of the Blue Cliff
attention deficit/hyperactivity dis School of Therapeutic Massage in
order, anxiety, depression, fatigue Metairie, Louisiana, and maintains
and pain management. She also a practice in the Greater New
provides massage for those deal Orleans Area. Glenn is the author
ing with everything from stress management massage to re of the textbook, Research Methods
habilitative care upon physician referral. Additionally, Sandy for Massage and Holistic Therapies (Mosby, 2006) and the tertiary
has developed and supervises a student massage clinic with author (along with Sandy Fritz and Leon Chaitow) of Clinical
the Detroit Lions professional football team. She also pro Massage in the Healthcare Setting (Mosby, 2008).
vides professional sports massage and rehabilitation for in
dividual professional football players and basketball players.
Bob King, LMT, NCTMB
As a worldwide public speaker and stress management educa
Bob King has authored manuals,
tor, Sandy provides programs for the public in the corporate
books, videos, curricula and
arena.
numerous clinical articles in a
massage therapy career spanning
Beverley Giroud, LMT, NCTMB more than three decades. He is a
Beverley Giroud is a massage Cortiva Educational Consultant
therapist and personal trainer and conducts advanced myofascial
with a private practice in Tucson, trainings throughout the country.
Arizona. She is a graduate of the He is the founder and past
Desert Institute of the Healing Arts president of the Chicago School of
and holds additional certifications Massage Therapy, served two terms
in orthopedic massage through as AMTA National President, and
OMERI and Exercise Coaching is widely regarded as a successful
through the Chek Institute. She has innovator, activist, and educator
been a massage therapy instructor within the profession. Bob serves on the Editorial Advisory
for eight years. She also teaches Board of the Journal of Bodywork and Movement Therapies. In
business and ethics classes. Her 2004, he received the Distinguished Service Award for the
private practice specializes in injury Massage Therapy Foundation for visionary leadership.
assessment, management and
rehabilitation, as well as corrective George Kousaleos, BA, LMT, NCTMB
exercise for injury and postural dysfunction. Prior to becoming
George Peter Kousaleos is the
a massage therapist, Beverley earned a Bachelor of Science
founder and President of the
degree in civil engineering at the University of Delaware.
CORE Institute School of Mas
sage Therapy and Structural Body
Gil Hedley, PhD work in Tallahassee, Florida. A
Gil Hedley has taught his 6-Day graduate of Harvard University,
Intensive Hands-On Human Dis George has taught Structural Inte
section Workshops to professionals gration, Myofascial Therapy, and
from virtually all health and fitness Sports and Performance Body
modalities internationally since work workshops and certification
1995. Documenting his unique seminars throughout the United
approach to human anatomy, his States, Canada, and Europe. Dur
Integral Anatomy Series on DVD has ing his career he has volunteered
now been sold into 27 countries. A for leadership positions on the
presenter at the First International National Certification Board,
Fascia Congress in 2007, Gil is also a the Florida Licensure Board, and the Massage Thera
regular contributor of feature articles py Foundation. His involvement in Olympic Sports
for Spirituality & Health Magazine, among others, and his second Massage included serving as General Manager of the 1996
book is due out in 2009. British Olympic Preparation Camp Sports Massage Team and
Co-Director of the 2004 Athens Olympic International Sports
Massage Team.
vi Contributors and DVD Presenters
Whitney Lowe, LMT program in Ontario, Canada, and an additional 15 years expe
Whitney Lowe is a recognized rience in leading post-graduate workshops.
authority on pain and injury
Monica J. Reno, LMT, NCTMB
treatment with massage therapy.
He is the author of the books, Monica Reno has been an LMT since
Orthopedic Assessment in Massage 1984. She is licensed in both New
Therapy (David Scott, 2006), York and Florida. She is co-owner
and Orthopedic Massage: Theory of the Tuscany Day Spa & Salon, in
and Technique (Mosby, 2003). In The Villages, Florida. Prior to that,
1994 he founded the Orthopedic she operated Allied Therapeutic
Massage Education & Research Protocols in Winter Park, Florida,
Institute (OMERI) to provide specializing in the treatment of
massage therapists the advanced education they would need endurance athletes. Monica was
for treating orthopedic soft-tissue disorders. He is currently Director of Education for the
a member of the editorial advisory board of the journal of Central Florida School of Massage
Bodywork & Movement Therapies and has been a regular featured Therapy for 8 years. She practiced Massage for 12 years in New
author in publications such as Massage Magazine, Massage York where she was part of the treatment team for the New York
Today and The Journal of Soft-Tissue Manipulation. Jets, and she worked with George Rizos, DC. Currently, Monica
is a member of the Board of Directors for NCBTMB.
Bob McAtee, NCTMB, CSCS, CPT
Susan G. Salvo, BEd, LMT, NCTMB
Bob McAtee is a veteran sports mas
sage therapist, author, educator, and Susan Salvo graduated from the
inventor. He maintains an active, in New Mexico School of Natural
ternational sports massage practice Therapeutics in 1982. Ms. Salvo is
in Colorado Springs, Colorado, and a nationally known author, having
regularly presents workshops on written Massage Therapy: Principles
facilitated stretching, massage, and and Practice (Saunders, 2007) and
soft-tissue injury care nationally Mosby's Guide to Pathology for the
and internationally. Massage Therapist (Mosby, 2008).
She has written the chapter "Teach
Bob is nationally certified in
ing to Students with Learning
Therapeutic Massage and Bodywork
Challenges" for Teaching Massage
(1992), is a Certified Strength and
(Lippincott Williams & Wilkins,
Conditioning Specialist (NSCA, 1998), and a certified personal
2008). She has also contributed "Geriatric Massage" for Mo
trainer (ACE, 2006).
dalities for Massage and Bodywork (Mosby, 2008). Ms. Salvo is
He is also the author of the book, Facilitated Stretching
one of the featured experts interviewed in the documentary
(Human Kinetics Publishers, 2007), from which the stretches
film, "History of Massage Therapy in the United States" re
demonstrated in the video are taken.
leased in 2007. She holds a baccalaureate degree in education
and is currently working on her Masters of Science in Educa
Thomas Myers, LMT, NCTMB, ARP
tional Leadership and Instructional Technology. Ms. Salvo is
Thomas Myers is the author of
the director of the Louisiana Institute of Massage Therapy.
Anatomy Trains: Myofascial Me
ridians for Manual and Movement
Diana L. Thompson, LMP
Therapists (Churchill Livingstone,
2001), as well as numerous articles. Diana L. Thompson, a licensed
Tom directs Kinesis, Inc., which of massage therapist for 25 years, has
fers professional certification train a private practice in Seattle, Wash
ings and continuing education ington, treating acute and chronic
worldwide. Tom studied with Drs. neuromusculo-skeletal and lym
Ida Rolf, Moshe Feldenkrais, and phatic disorders. She authored
Buckminster Fuller, and has prac Hands Heal: Communication, Docu
ticed integrative bodywork for over mentation and Insurance Billing for
30 years in a variety of clinical and cultural settings. Manual Therapists, Third Edition
(Lippincott Williams & Wilkins,
2005). Diana lectures at massage,
Fiona Rattray, RMT
acupuncture, midwifery, chiroprac
A registered massage therapist since
tic, physician and physical therapy conferences internation
1983, Fiona is co-author of Clinical
ally, and is a consultant for massage therapy research with The
Massage Therapy: Understanding, As
Center for Health Studies in Seattle. She is the President of
sessing and Treating Over 70 Condi
the Massage Therapy Foundation, a philanthropic non-profit
tions (Talus, 2001). She has 11 years
organization whose mission is to advance the knowledge and
experience teaching the treatment
practice of massage therapy by supporting scientific research,
of injuries and postural dysfunc
education, and community service.
tion in the professional 2200-hour
Contributors and DVD Presenters vii
Benny Vaughn, LMT, ATC, CSCS, NCTMB ing one with Harvard Medical School's Osher Institute. She
Benny has 35 years experience helped develop "Touch, Caring and Cancer," a DVD of mas
treating athletes and active adults; sage instruction for caregivers. She was the 2003 AMTA Teacher
he is an expert in the assessment, of the Year. Tracy is the author of Medical Conditions in Massage
treatment, and care of athletic re Therapy (Lippincott Williams & Wilkins, 2009), a textbook for
lated soft-tissue dysfunction using massage therapy students, professionals, and clinics.
manual techniques. Mr. Vaughn
is a graduate of the University of Ruth Werner, LMP, NCTMB
Florida, College of Health and Hu Ruth Werner is a massage therapist,
man Performance. He is a Certified writer, and award-winning educa
Athletic Trainer (NATA), a Certified tor with a passionate interest in the
Strength and Conditioning Spe role of bodywork for people who
cialist (NSCA), and is Nationally struggle with health. Her book, A
Certified in Therapeutic Massage Massage Therapist's Guide to Pathol
and Bodywork (NCrMB). He also holds a Florida Massage ogy (Lippincott Williams & Wilkins,
Therapy License. Benny has been on medical staff of the USA 2008), is in its 4"1 edition and is
Olympic and World Championship Track & Field. used in massage schools worldwide.
She writes columns for Massage
Tracy Walton, MS, LMT Today and Massage and Bodywork
magazine, and she teaches continu
Tracy Walton consults, writes, does
ing education workshops all over
research and teaches in massage
the country. She is also the Education Chair for the Massage
therapy. She has also practiced
Therapy Foundation, an organization dedicated to advancing
since 1990. She teaches "Caring
the knowledge and practice of massage therapy by supporting
for Clients with Cancer," a CE
scientific research, education, and community service.
course for massage therapists, and
she has taught oncology massage
nationally since 1998. Tracy has
researched massage therapy and
cancer for several projects, includ
ABOUT THE AUTHOR
Dr. Joe Muscolino has been teaching are available for Massage Therapists toward certification renewal,
musculoskeletal and visceral anat- In 2002, Dr. Muscolino participated on the NCBTMB Job Analy-
omy and physiology, kinesiology, sis Survey Task Force as well as the Test Specification Meeting as
neurology, and pathology courses a Subject Matter Expert in Anatomy, Physiology and Kinesiology,
at the Connecticut Center For He is also a member of the NCBTMB Exam Committee and has
Massage Therapy (CCMT) for over served on the NCBTMB Continuing Education Committee. Dr.
22 years. He has also been instru- Muscolino is also a member of the Educational Review Opera-
mental in course manual develop- tional Committee (EROC) of the Massage Therapy journal.
ment and assisted with curriculum Dr. Muscolino holds a Bachelor of Arts degree in Biology
development at CCMT He has pub- from the State University of New York at Binghamton, Harpur
lished The Muscular System Manual, College. He attained his Doctor of Chiropractic Degree from
Musculoskeletal Anatomy Coloring Western States Chiropractic College in Portland, Oregon, and
Book, Musculoskeletal Anatomy Flash- is licensed in Connecticut, New York, and California. Dr. Joe
cards, Kinesiology: The Skeletal System Muscolino has been in private practice in Connecticut for over
and Muscle Function, and Flashcards 23 years and incorporates soft tissue work into his chiropractic
for Bones, joints, and Actions of the Human Body, as well as articles practice for all his patients.
in the Massage Therapy journal and the journal of Bodywork and If you would like further information regarding Dr.
Movement Therapies. Flashcards for Palpation, Trigger Points, and Muscolino's publications listed above, or if you are an
Referral Patterns and Mosby's Trigger Point Flip Chart with Referral instructor and would like information regarding the many
Patterns and Stretching will both publish in December of 2008. supportive materials such as Power Point slides, test banks of
Dr. Muscolino runs continuing education workshops on such questions, or TEACH Instructor Resources, please visit http://
topics as anatomy and physiology, kinesiology, deep tissue mas- www.us.elsevierhealth.com. If you would like to contact Dr.
sage, joint mobilization, as well as cadaver workshops. He is an Muscolino directly, please contact him at his website: www.
NCBTMB approved provider of continuing education and CEUs learnmuscles.com.
FOREWORD
As a massage therapy educator and writer well into my third and Stretching is its emphasis on how muscles don't act
decade in this field, I know a few things about communicating independently, but interact seamlessly in an integrated
with students and practicing therapists. I know that students whole. This awareness helps users of the book to understand
and practitioners of massage and bodywork have remarkable how weakness or restriction in one area can create pain and
diversity in age, ethnicity, and basic skill levels—and educators dysfunction in another. The critical thinking skills associated
have to find a way to reach everyone regardless of these with this level of understanding are necessary for every
differences. People in this field often don't connect well with outstanding massage therapist.
dry or abstract material; educators have to find a way to make The Muscle and Bone Palpation Manual identifies the needs
information come alive. And massage therapists get especially of massage practitioners and students, and consistently meets
excited when they find that what they are learning has a direct them with accessible language, beautiful art that represents a
application to the work they want to do. The goal for educators wide range of bodies, and a sharp focus on how this knowledge
is always to find ways to make their topics pertinent to the can inform the way every massage therapist touches another
choices their students make in the session room. human being. Meticulous attention to detail and obvious
Many massage therapy students approach the project of care about accuracy is visible on every page. This book can
learning muscle anatomy with a certain degree of apprehen provide tools for massage therapists and students not only to
sion. They look at those long lists of muscles with attachments become soft tissue experts, but to communicate professionally
and functions, and feel utterly overwhelmed. The topic seems with other health care providers in order to obtain the best
abstract, the language is unfamiliar, and the goal of truly "get outcomes for their clients.
ting it" seems out of reach. Gifted educators find ways to make I have always worked hard to raise the bar for massage edu
this information jump off the page, but the process is nonethe cation. In my writing, my work in the classroom, in continuing
less daunting. What a gift to have a text that illustrates these education workshops, and with the Massage Therapy Founda
concepts with thoroughness, clarity, and beauty. tion I have looked for opportunities to make it clear that the
Learning the muscles is a critical milestone in the education potential for massage to impact lives is greater than we can
of every massage therapist, but those of us who have been in imagine. The Muscle and Bone Palpation Manual is a tool that
this business for a while know that it is only the first step. can help to launch new generations of therapists in that ambi
Putting that information to use—whether we're helping tious direction, and I am delighted to see it enter the market
someone get a good night's sleep, recover from an injury, or place. It, and texts like it, will continue to set the best possible
train for a marathon—requires an ability to use facts about standards in massage education: a goal that supports us all.
muscles in ways that can be hard to predict. This work requires
a solid foundation in the basics, along with imagination and Ruth Werner, LMP, NCTMB
the ability to analyze subtle bits of information that only Layton, Utah
comes with experience. It helps, though, to have a text that August 2008
instills this kind of thinking.
One of the features that truly distinguishes The Muscle and
Bone Palpation Manual with Trigger Points, Referral Patterns,
VII