Massage Flashcards
Pathway of Digestion
1) Mouth and Pharynx
2) Esophagus
3) Stomach
4) Small Intestine
5) Large Intestine
6) Liver and Gallbladder**
7) Pancreas**
* *accessory organs
Mouth and Pharynx’s role in digestion
Mastication=chewing
saliva=libricant to help food travel GI tract, begin chemical digestion
saliva contains amylase-enzyme that breaks down starches
Amylase
1st chemical that food encounters enzyme that breaks down starches
Changing names of food through digestion system
Food > Bolus/Chyme > Feces
Esophagus
muscular tube posterior to the trachea that connects the pharynx to the stomach
6 Functions of the Digestive System
1) ingestion–food comes in
2) secretion–saliva chemicals release to break it down
3) digestion–taking what we can
4) motility–move the stuff through
5) absorption–nutrients and fluid blending into body
6) elimination–leave the body
Pepsin
protein-digesting enzyme secreted in the stomach
Chyme
semiliquid substance formed in stomach from food and gastric juices mixing
Small Intestine
most digestion and absorption happens here
3 segments: duodenum, jejunum, ileum
Large Intestine (name sections)
cecum>ileocecal valve>ascending colon>hepatic flexure>transverse colon>splenic flexure>descending colon>sigmoid colon>colon>rectum>anal canal
Peristalsis moves food along
Liver and Gallbladder
Liver’s lobes divided into functional units called lobules made up of hepatocytes (secrete bile–focus on fats/lipids)
Gallbladder delivers bile
Liver is nutrient storage facility–converts glycogen into glucose
Filters and detoxifies blood
Liver’s roles: digestive, storage, metabolic
Pancreas
enzymes from pancreas are transported to the duodenum, where they are active in the chemical digestion of proteins, fats, and carbs
Rugae
folds in the inner-mucosal layer of the stomach to allow it to expand
Hydrochloric Acid
acid released in the stomach to begin the breakdown of proteins and destroy pathogens
Peristalsis
a series of wave-like contractions and relaxation in the smooth muscle layer, which propels food along the GI tract
Medullary Cavity
Cavity inside long bone.
Endosteum lines this ___. In adults it is filled with yellow bone marrow.
3 Portions of a Longbone
epiphysis–end of long bone, contains red bone marrow
metaphysics–neck of bone, where epiphyseal plate “growth plate”
diaphysis–main shaft
2 Types of Bone Tissue
Compact bone tissue aka cortical–made up of osteons
Spongey Bone aka cancellous
Osteogenic Cells
The only bone cell capable of mitosis (cell division)
genic= to produce
Osteocyte
Mature bone cell
cyte=cell
Osteoclasts
Bone Destroyers
clast=to break or destroy (think catastrophe)
Osteoblasts
Bone Builders
Blasts=germinate, bud, grow
Ossification
bone formation
Deposition
building up of new bone tissue
Resorption
breakdown of bone tissue
Remodeling
natural cycle that bones undergo to grow and repair themselves
General History of Massage
15,000 BCE: European cave art depict healing touch
3,000 BCE: Oldest book on massage–China
2,500 BCE: Egyptian paintings
776 BCE: massage before sporting events
460-375 BCE: Hippocrates “Father of Western Medicine” spoke about massage
100-40 BCE: Julius Cesar used massage to help epilepsy and neuralgia
100 CE: first schools of massage developed
Middle Ages (1300-1400): “folk healers” using massage persecuted in West
1517-1590: massage used for joint stiffness and post-saving wound healing
History of Swedish Massage
1776-1839: Henrik Ling-Swedish physiologist, gymnast, fencing
1839-1909: Johann Metzger: medical profession accepted massage
1856: Two Taylor brothers wrote American textbook on massage
1852-1943: Dr. John Harvey Kellogg published magazine to popularize massage
scandals of late 1800s: brothels
1894: formed Society of Trained Masseuses
1920s: Chartered Society of Massage Medical Gymnastics
1960s: mixed messages with “Massage parlors”
1970s-80s: massage seen as luxury
1990s: accepted more by medical profession
1992: National Certification Board for Therapeutic Massage and Bodywork
Trochanter (Bony Landmark)
A large blunt process ex. greater _____ of femur
Head (Bony Landmark)
A large rounded end of a long bone, usually set off from the rest of the bone by a “neck”. ex. the ___ of the humerus or femur
Crest (Bony Landmark)
A prominent ridge ex. illiac ___
Fossa (Bony Landmark)
A basin-like depression in a bone ex. supraspinous
Epicondyle (Bony Landmark)
A bump above a condyle ex. the medial and lateral ___ of the humerus are located above the medial and lateral condyles of the humerus
Notch (Bony Landmark)
A deep indentation in a bone ex. sciatic ____
Angle (Bony Landmark)
A diverging of 2 bony edges from common point ex. superior and inferior ____ of the scapula
Tubercle (Bony Landmark)
A small bump ex. greater or lesser ____ of humerus
Tuberosity (Bony Landmark)
A large, often rough bump ex. ischial ____
Line (Bony Landmark)
A ridge that doesn’t stick up very far ex. the ____ aspera of the femur
Process (Bony Landmark)
A broad designation for bump on a bone ex. mastoid ____, xiphoid _____
Foramen (Bony Landmark)
A hole in a bone ex. ____ magnum on a skull, ____ on sacrum
Spine (Bony Landmark)
An abrupt or pointed projection
ex. the ___ of the scapula, the anterior superior iliac ____
Facet (Bony Landmark)
A smooth, mostly flat surface on a bone
ex. the ____ of the vertebrae
Condyle (Bony Landmark)
the rounded end of a long bone, usually not set off by a neck, usually smaller than a head
ex. the medial and lateral ____ of the femur
Axial Skeleton
80 bones: skull, vertebral column, ribs, sternum
Appendicular Skeleton
126 bones: clavicle to arm, illiam, pubis, ischium to leg
Planes of the body
Sagital, Coronal/Frontal, Transverse
Sagital: cuts right and left
Coronal: cuts front and back
Transverse: cuts top and bottom (inferior=caudal, superior=cephalic)
Benefits of Massage
relaxation
feels good
increases circulation-relaxes muscle spasms, relieves tension, improve muscle tone, return blood flow to heart
prevent or delay muscle atrophy from forced inactivity
stimulates lymphatic circulation–help elimination of wastes and toxic debris
may help movement of intestine, reduce constipation
stretch fascia, increase ROM
prevent formation of adhesions
decrease inflammation
alleviate pain
reduce insomnia
reduce sense of isolation
release repressed emotional energy
Cautions and Contraindications of Massage
broken skin, rashes, skin infections
inflammation (tendinitis, sprain, post-injury, swelling)
pain beyond “good hurt” of massage
lack of sensory feeling (diabetes, neuropathy)
varicose veins
gastritis, stomach ulcers
Ida Rolf
Rolfing, contributed to Deep Tissue
Janet Travell
Trigger Point Therapy
Margaret Knott and Dorothy Vass
wrote book on Proprioceptive Neuromuscular Facilitation
sign vs. symptom
sign: objective indication of disease that is usually measurable
symptom: subjective indicator of disease that is not easily measured or quantified
Erector Spinae Group Origin
Common tendon (thoracolumbar aponeurosis) that attaches to the posterior surface of sacrum, iliac crest, spinous processes of the lumbar and last 2 thoracic vertebrae
Erector Spinae Group Action
Unilaterally: Laterally Flex vertebral column to the same side
Bilaterally: Extend the vertebral column
Erector Spinae Group Insertion
Various attachments at the posterior ribs, spinous and transverse processes of thoracic and cervical vertebrae and mastoid processes of temporal bone
Hamstrings Semitendinosus Origin
Ischial tuberosity
Hamstrings Semitendinosus Insertion
Proximal, medial shaft of the tibia at pes anserinus tendon
Hamstrings Semitendinosus Action
Flex the knee (tibiofemoral joint)
Medially rotate the flexed knee (T/F joint)
Extend the hip (coral joint)
Assist to medially rotate the hip (coral joint)
Tilt the pelvis posteriorly
Hamstrings Semimembranosus Action
Flex the knee (T/F joint)
Medially route the flexed knee (T/F joint)
Extend the hip (coral joint)
Assist to medially rotate the hip (coral joint)
Tilt the pelvis posteriorly
Triceps Brachii Origin
Long head: infraglenoid tubercle of scapula
Lateral head: posterior surface of proximal half of humerus
Medial head: posterior surface of distal half of the humerus
Triceps Brachii Action
all heads: extend the elbow (humeroulnar joint)
long head: extend the shoulder (glenohumeral joint)
adduct the shoulder (gH joint)
Triceps Brachii Insertion
olecranon process of the ulna
Rhomboids Origin
Major: spinous processes of T2-T5
Minor: spinous processes of C7-T1
Rhomboids Insertion
Major: medial border of the scapula between the spine of the scapula and inferior angle
Minor: upper portion of medial border of the scapula, across from spine of the scapula
Rhomboids Major and Minor Action
Adduct the scapula (ST joint)
Elevate the scapula
Downwardly rotate the scapula
Rotator Cuff Muscles: Teres Minor Action
Laterally rotate the shoulder (gH)
Adduct the shoulder (gH)
Stabilize the head of the humerus in glenoid cavity
Rotator Cuff Muscles: Teres Minor Origin
Upper 2/3 of lateral border of scapula
Rotator Cuff Muscles: Teres Minor Insertion
Greater tubercle of the humerus
Sternocleidomastoid Origin
Sternal head: Top of manubrium
Clavicular head: medial 1/3 of the clavicle
Sternocleidomastoid Insertion
Mastoid process of the temporal bone and the lateral portion of superior nuchal line of occiput
Sternocleidomastoid Action
Unilaterally: Laterally flex the head and neck to same side. Rotate the head and neck to opposite side (contralateral rotator)
Bilaterally: Flex the neck. Assist to elevate the ribcage during inhalation.
Quadratus Lumborum Origin
Posterior iliac crest
Quadratus Lumborum Insertion
Last rib and transverse processes of first through 4th lumbar vertebrae
Quadratus Lumborum Action
Unilaterally: Laterally tilt (elevate) the pelvis. Laterally flex the vertebral column to the same side.
Bilaterally: Assist to extend the vertebral column. Fix the last rib during forced inhalation and exhalation.
Pectoralis Minor Action
Depress the scapula
Abduct the scapula
Downwardly rotate the scapula
w/ the scapula fixed: assist to elevate the thorax during forced inhalation
Pectoralis Minor Origin
3rd, 4th, 5th ribs
Pectoralis Minor Insertion
Medial surface of coracoid process of scapula
Trapezius Action
Bilaterally: Extend the head and neck
Unilaterally: Laterally flex the head and neck to same side
Rotate the head and neck to the opposite side (contralateral rotator)
Elevate the scapula (ST)
Upwardly rotate the scapula (ST)
Middle fibers: Adduct and stabilize the scapula
Lower fibers: Depress and upwardly rotate the scapula
Trapezius Origin
External occipital protuberance, medial portion of superior nuchal line of the occiput, ligaments nuchal and spinous processes of C7-T12
Trapezius Insertion
Lateral 1/3 of clavicle, acromion and spine of the scapula
Serratus Anterior Action
Action with origin fixed: Abduct the scapula Upwardly rotate the scapula Depress the scapula Hold the medial border of scapula against ribs
With scapula fixed:
May act to elevate the thorax during forced inhalation
Serratus Anterior Insertion
Anterior surface of medial border of the scapula
Serratus Anterior Origin
External surfaces of upper 8 or 9 ribs
Deltoid Insertion
Deltoid tuberosity
Deltoid Origin
Lateral 1/3 of clavicle, acromion and spine of scapula
Deltoid Action
All fibers: Abduct the shoulder (gH joint) Anterior: flex the shoulder (gH) Medially rotate the shoulder (gH) Horizontally adduct the shoulder (gH) Posterior: Extend the shoulder (gH) Laterally rotate the shoulder (gH) Horizontally abduct the shoulder (gH)
Middle scalene Origin
Transverse processes of 2nd-7th cervicle vertebrae (posterior tubercles)
Middle Scalene Insertion
1st Rib
Abdominals-External Oblique Origin
External surfaces of 5th-12th ribs
Abdominals-External Oblique Action
Unilaterally:
Laterally flex vertebral column to the same side
Rotate vertebral column to the opposite side
Bilaterally:
Flex the vertebral column
Compress abdominal contents
Abdominals-External Oblique Insertion
Anterior part of the iliac crest, abdominal aponeurosis to line alba
Hamstrings- Semimembranosus Origin
Ischial Tuberosity
Hamstrings-Semimembranosus Insertion
Posterior aspect of medial condyle of tibia
Latissimus Dorsi Action
“Handcuff muscle”
Extend the shoulder (gH)
Adduct the shoulder (gH)
Medially rotate the shoulder (gH)
Latissimus Dorsi Origin
Inferior angle of scapula
Spinous Processes of last 6 thoracic vertebrae
last 3 or 4 ribs
thoracolumbar aponeurosis and posterior iliac crest
Latissimus Dorsi Insertion
Intertubercular groove of the humerus
Rotator Cuff Muscles: Subscapularis Origin
sub scapular fossa of the scapula
Rotator Cuff Muscles: Subscapularis Action
Medially rotate the shoulder (gH)
Stabilize the head of the humerus in glenoid cavity
Rotator Cuff Muscles: Subscapularis insertion
Lesser tubercle of the humerus
Biceps Brachii Insertion
Tuberosity of the radius and aponeurosis of the biceps brachii
Biceps Brachii Origin
Short head: coracoid process of scapula
Long head: supraglenoid tubercle of scapula
Posterior Scalene Origin
Transverse processes of 6th-7th cervical vertebrae (posterior tubercles)
Posterior Scalene Insertion
2nd rib
Anterior Scalene Origin
Transverse processes of 3rd-6th cervical vertebrae (anterior tubercles)
Anterior Scalene Insertion
1st rib
All Scalenes Action
Unilaterally:
with ribs fixed: laterally flex the head and neck to the same side (all)
rotate head and neck to the opposite side (all) (contralateral rotator)
Bilaterally:
elevate the ribs during inhalation (all)
flex the head and neck (anterior)
Pectineus Insertion
Pectineal line of femer
Pectineus Origin
Superior ramps of pubis
Rotator Cuff Muscle-Supraspinatus Origin
Supraspinous fossa of the scapula
Rotator Cuff Muscle-Supraspinatus Action
Abduct the shoulder (gH)
Stabilize the head of the humerus in glenoid cavity
Rotator Cuff Muscle-Supraspinatus Insertion
Greater Tubercle of the humerus
Rotator Cuff Muscle-Infraspinatus Action
Laterally rotate the shoulder (gH)
Adduct the shoulder (gH)
Stabilize the head of the humerus in glenoid cavity
Rotator Cuff Muscle-Infraspinatus Origin
Infraspinous fossa of the scapula
Rotator Cuff Muscle-Infraspinatus Insertion
Greater tubercle of the humerus
Abdominals-Internal Oblique Origin
Lateral inguinal ligament, iliac crest and thoracolumbar fascia
Abdominals-Internal Oblique Action
Unilaterally: Laterally flex vertebral column to the same side. Rotate vertebral column to the same side Bilaterally: Flex the vertebral column Compress abdominal contents
Abdominals-Internal Oblique Insertion
Internal surface of lower three ribs, abdominal aponeurosis to line alba
Rectus Abdominus Origin
Public Crest, pubic symphysis
Rectus Abdominus Action
Flex the vertebral column
Tilt pelvis posteriorly
Rectus Abdominus Insertion
Cartilage of 5th, 6th, 7th ribs and xiphiod process
Gluteus Minimus Origin
Gluteal surface of the allium between the anterior and inferior gluteal lines
Gluteus Minimus Insertion
Anterior aspect of greater trochanter
Gluteus Medius Action
All fibers: Abduct the hip Anterior fibers: flex the hip medial rotate the hip Posterior fibers: Extend the hip Laterally rotate the hip
Gluteus Medius Origin
Gluteal surface of allium, between posterior and anterior gluteal lines, just below the iliac crest
Gluteus Medius Insertion
Lateral aspect of greater trochanter
Gluteus Maximus Origin
coccyx, edge of sacrum, posterior iliac crest, sacrotuberous and sacroiliac ligaments
Gluteus Maximus Insertion
Illiotibial tract (upper fibers) and gluteal tuberosity (lower fibers)
Gluteus Maximus Action
All fibers: Extend the hip (coral joint) Laterally rotate the hip Abduct the hip Lower fibers: Adduct the hip
Tensor Fasciae Latae Origin
Illiac crest, posterior to the ASIS
Tensor Fasciae Latae Insertion
Illiotibial tract
Tensor Fasciae Latae and Illiotibial Tract Action
Flex the hip
Medially rotate the hip
Abduct the hip
Adductor Brevis Origin
Inferior ramus of pubis
Adductor Brevis Insertion
Pectineal line and medial lip of lines aspera
Adductor Longus Origin
Pubic tubercle
Adductor Longus Insertion
Medial lip of lines aspera
Gracilis Insertion
Proximal, medial shaft of tibia at pet anserinus tendon
Gracilis Origin
Inferior ramus of pubis
Gracilis Action
Adduct the hip
Medially rotate the hip
Flex the knee (tibiofemoral joint)
Medially rotate the flexed knee (TF joint)
Adductor Magnus Origin
Inferior ramus of the pubis, ramus of ischium and ischial tuberosity
Adductor Magnus Insertion
Medial lip of lines aspera and adductor tubercle
Adductor Group (Magnus, Longus, Brevis, Pectinus, Gracilis) Action
Adduct the hip (coral joint)
Medially rotate the hip
Assist to flex the hip (not Gracilis)
Posterior fibers of adductor Magnus: extend the hip
Piriformis Origin
Anterior surface of sacrum
Piriformis Insertion
Superior aspect of greater trochanter
Piriformis Action
Laterally rotate the hip
Abduct the hip is flexed
Illiopsoas (Psoas Major and Illiacus) Origins
Psoas Major: bodies and transverse processes of lumbar vertebrae
Illiacus: iliac fossa
Illiopsoas (Psoas Major and Illiacus Insertion
Psoas Major: lesser trochanter
Illiacus: lesser trochanter
Illiopsoas Action
with origin fixed:
flex the hip, may laterally rotate the hip
with the insertion fixed:
flex the trunk toward the thigh
tilt pelvis anteriorly
unilaterally:
assist to laterally flex the lumbar spine
Flexor Carpi Radialis Action
Flex the wrist (radoiocarpal joint)
Abduct the wrist
May assist to flex the elbow (humeroulnar joint)
Flexor Carpi Radialis Insertion
Bases of 2nd and 3rd metacarpals
Flexor Carpi Radialis Origin
Common flexor tendon from medial epicondyle of humerus
Quadriceps Femoris Group Action
All: Extend the knee (tibiofemoral joint)
Rectus Femoris: flex the hip (coral Joint)
Quadriceps Femoris Group Insertion
Tibial tuberosity (via the patella and patellar ligament)
Quadriceps Femoris Group Origin- Rectus Femoris
Anterior Inferior Iliac Spine (AIIS)
Quadriceps Femoris Group Origin- Vastus Medialis
Medial lip of linea aspera
Quadriceps Femoris Group Origin- Vastus Lateralis
Lateral lip of linea aspera, gluteal tuberosity and greater trochanter
Quadriceps Femoris Group Origin- Vastus Intermedius
Anterior and lateral shaft of the femer
Extensor Digitorum Action
Extend the 2nd-5th fingers (metacarpophalangeal and interphalangeal joints)
Assist to extend the wrist (radoiocarpal joint)
Extensor Digitorum Origin
Common extensor tendon from the lateral epicondyle of humerus
Extensor Digitorum Insertion
Bases of middle and distal phalanges of 2nd-5th fingers
Pectoralis Major Origin
Medial half of clavicle, sternum and cartilage of 1st-6th ribs
Pectoralis Major Insertion
Crest of greater tubercle of humerus
Pectoralis Major Action
All fibers: Adduct the shoulder (gH) Medially rotate the shoulder (gH) Assist to elevate the thoracic during forced inhalation (w/ arm fixed) Upper fibers: Flex the shoulder (gH) Horizontally adduct the shoulder (gH) Lower fibers: Extend the shoulder (gH)
Hamstrings-Biceps Femoris Origin
Long head: ischial tuberosity
Short head: Lateral lip of linea aspera
Hamstrings-Biceps Femoris Action
Flex the knee (tibiofemoral joint) Laterally rotate the flexed knee (TF) Long head: Extend the hip (coral joint) Long head: Assist to laterally rotate the hip (coral joint) Tilt the pelvis posteriorly
Hamstrings-Biceps Femoris Insertion
Head of the fibula
Biceps Brachii Action
Flex the elbow (humeroulnar joint)
Supinate the forearm (radioulnar joint)
Flex the shoulder (gH)
Tibialis Posterior Insertion
All 5 tarsal bones and bases of 2nd-4th metatarsals
Tibialis Posterior Action
Invert the foot
Plantar flex the ankle
Tibialis Posterior Origin
Proximal, posterior shafts of tibia and fibula, and interosseous membrane
Levator Scapula Insertion
Medial border of scapula, between superior angle and superior portion of spine of scapula
Levator Scapula Origin
Transverse processes of 1st-4th cervical vertebae
Levator Scapula Action
Unilaterally: Elevate the scapula (scapulothoracic joint) Downwardly rotate scapula (ST) Laterally flex the head and neck Rotate the head and neck to same side Bilaterally: Extend the head and neck
Tibialis Anterior Insertion
Medial cuneiform and base of the 1st metatarsal
Tibialis Anterior Origin
Lateral condyle of tibia, proximal, lateral surface of tibia and interosseous membrane
Tibialis Anterior Action
Invert the foot
Dorsiflex the ankle (talocrural joint)
Extensor Digitorum Longus Action
Extend the 2nd-5th toes (metatarsophalangeal and interphalangeal joints)
Dorsiflex the ankle (talocrural joint)
Evert the foot
Extensor Digitorum Longus Insertion
Middle and distal phalanges of 2nd-5th toes
Extensor Digitorum Longus Origin
Lateral condyle of tibia, proximal, anterior shaft of fibula and interosseous membrane
Gastrocnemius Action
Flex the knee (TF joint)
Plantar flex the ankle (talocrural joint)
Gastrocnemius Origin
condyles of the femer, posterior surfaces
Gastrocnemius Insertion
calcaneus via calcanea tendon
Soleus Origin
solar line, proximal, posterior surface of tibia and posterior aspect of head of fibula
Soleus Insertion
calcaneus via calcanea tendon
Soleus Action
Plantar flex the ankle (talocrural joint)
Peroneus Longus Insertion
Base of the 1st metatarsal and medial cuneiform
Peroneus Longus Origin
Head of fibula and proximal 2/3 of lateral fibula
Peroneus Longus Action
Evert the foot
Assist to plantar flex the ankle
Tsubo Point ST-36
“Leg 3 mile”-regulates chi and blood SP/ST, strengthens weak and deficient conditions.
Location: 4 fingers below patella, 1 finger width from anterior crest of tibia
Tsubo Point UB-60
“Asprin for the back”-relaxes tendons, benefits the back.
Location: In the depression between lateral malleolus and calcanea tendon
Tsubo Point KI-3
“Bigger Stream”-benefits kidneys, strengthens lumbar region
Location: In depression between medial malleolus and calcanea tendon
Tsubo Point UB-2
“Drilling Bamboo”-clears vision, relieves pain in the head.
Location: Medial end of eyebrow, on supraorbital notch
Tsubo Point LI-4
“Great Eliminator”-stops pain, circulates chi & blood
Location: In web between 1st-2nd metatarsal
Tsubo Point LI-20
“Welcome Fragrance”-opens nasal passages
Location: lateral wings of nose in the depression
Shiatsu Cautions
- During acute illness, fever, contagious disease
- Osteoporosis (light pressure ok)
- High blood pressure, epilepsy (light pressure ok)
- Varicose veins, hemophilia
- Wounds, burns
- Fractures
- Inflamed joints
- skin rash, bruises
- medication that prevents clear feedback
- first 3 months of pregnancy
- during pregnancy, avoid LI-4, SP-6, GB-21, KI-3, UB-60,
- avoid intense work on lower legs
Ipsilateral Rotator
rotates to the same side
Contralateral Rotator
rates to the opposite side ex. sternocleidomastoid & scalenes
High Risk Pregnancies
- *need written release from healthcare provider before receiving massage**
- mother is under 20 or over 35
- complications in previous pregnancies
- 3 or more consecutive miscarriages
- multiple gestation (twins, triplets, etc)
- uterine abnormalities (fibroids, surgery, etc)
- Rh-negative mother or genetic problem
- fetal genetic disorders
- drug or other hazardous material exposure
- maternal illnesses: cardiac & renal disease/disorders, connective tissue disorders, liver disease/disorders, diabetes mellitus, chronic hypertension
Pregnancy Precautions/Contraindications
- avoid completely if client is on bed rest (clots can form)
- avoid percussion in lower legs
- varicose veins-moderate pressure proximal-distal to them. on them, only feather light pressure
- avoid acupressure, reflections points, cross-fiber friction, deep tissue and trigger points on feet, lower leg and medial thigh
- avoid these points: SP-6, UB-60, KI-3