Fitness topic: A Personal View on Recreational Therapy of Massage

“Recreational therapy, also referred to as recreation therapy and therapeutic recreation, contributes to the broad spectrum of health care through treatment, education, and the provision of adapted recreational opportunities — all of which aid in improving and maintaining physical, cognitive, emotional, and social functioning, preventing secondary health conditions, enhancing independent living skills and overall quality of life.”, cited from wikipedia encyclopedia. As you can see, it is a topic with a broad spectrum; so definitely, I am not going to talk all about it. In this article, I am going to cover some of the fundamental issues highlighted in sports medicine. However, if you are a sports medicine practitioner, then this article probably will be just a review of your knowledge except some of my personal opinions and that knowledge belong to the TCM field.

      Currently, I am serving as a massage therapist in the Olympic Village, of course, like many of my schoolmates; it is a volunteer position other than paid position. And no doubt that is why we can ourselves volunteers, and we serve the athletes and coaches as well as officials who live in this village with both our heart and soul. Once again, even with a strong devoted mind, it doesn’t seem enough. Without the professional knowledge backup, how would a satisfactory massage/medical service come out? So it let me think again what proficiencies should a massager have got?

     For a real traditional Chinese medicine type massager, probably, he or she doesn’t need to know modern anatomy, because our ancestors rarely know what the human body is made of (leave the qi, blood, essence and fluid alone). But for a modern Chinese massager, no matter your knowledge is TCM-based or modern science-based, you have to know the anatomy and some of the important issues like special tests in the orthopedics field. For the former issue, it can get you a clear idea for what you are doing or which part of the human body you are working on; whereas for the later issue, it really perfect your practice either as a orthopedists or massager or other medical practitioners, for it can elucidate the diagnosis and let you know what is wrong with this patient even though on most occasions nowadays, customers who go into your practicing room with the only wish of body relaxation. Given the TCM has no anatomy, some of you may claim it does have, but here I do not want to argue on this issue, because if it does have anatomy, this anatomy is not we talk nowadays (think about the five zang organs), how can it come up with a modern diagnosis? Also, some of you may claim, TCM does have a clear diagnosis, what I want to say, yes, it does, but this diagnosis is not what we commonly talk today and all lay people including most of our modern Chinese people, do not know what we are talking about. With only a TCM diagnosis, it is impossible for us to communicate with other medical professional from a different medical background. And then, it is impossible for the patients get the best medical service. Luckily, as time changes, things change, students in the TCM field change, and probably you have noticed that the name of diseases in some of our TCM textbooks begin to change, they are just getting more and more western medicine-styled.

      So, that is why, like lots of TCM practitioners nowadays, I highly approve of a conventional diagnosis plus TCM treatment. It makes things easier and much clearer and makes the motto “patients deserve the best medical service” possible to come true. Then, problems arrive, besides a kind fully devoted heart, how can we get there on the academic level？Here, I am going to take massage for an example, and hope you can get some new ideas for your practice.

I am a novice or intern, so, propositional to my current status, the knowledge or topic here will mainly be intern-level. One more thing, I am going to point out is, I am not going to cover the TCM part considering our university is the best one and my schoolmates are quite professional on that, and perhaps lots are better than me.

    Anatomy review: for a massager or a sports medicine related staff, I think it is of great significance to know the anatomy of the musculoskeletal part. The spine is the very important part; you have to know the morphological characters of every vertebra (cervical, thoracic, lumbar, sacrum, coccyx) and intervetebral disc, ligaments (ALL, PLL, ligamentum nuchae, interspinal/intertransverse). Knowledge of muscles including those deep small back muscles is a crucial prerequisite for your practice. If you know all the origination, insertion, innervation and function, a new world will be open for you.

     On the back, the erector spinae is the most important one, it arises by a broad tendon from posterior part of iliac crest, posterior surface of sacrum, sacraoiliac ligaments, sacral and inferior lumbar spinous process process and supraspinous ligaments. It branches into iliocostalis which inserts to luborum, thoracis, cervicis, longissimus which inserts to ribs between tubercles and angles to transverse processes in thoracic and cervical regions and mastoid process of the temporal bone, spinalis which inserts to more superiorly positioned spinous processes.

     Deep layer muscles include semispinalis which arises from transverse processes of C4-T12 vertebrae and inserts to spinous process of more superior vertebrae; multifidus which arises from posterior sacrum, posterior superior iliac spine of ilum, aponeurosis of erector spinae, sacroilia ligaments, mammillary processes of lumbar vertebrae, transverse processes of T1-T3, articular processes of C4-C7; rotatores which arises from transverses processes of vertebrae and inserts to junction of lamina and transverse process or spinous processes.

       Minor deep layer muscles include interspinalis, intertransversarii, levatores costarum (they arise from tips of transverse processes of C7-T11 vertebrae and pass inferolaterally and insert on ribs between tubercle and angle)

      Others are universally known ones which include serratus posterior superior and inferior, spenius (arises from nuchal ligament and spinous processes of C7 –T3 or T4 vertebrae and one bundle named splenius capitis inserts to mastoid process and lateral third of superior nuchal line of occipital bone, the other named splenius cervicis which inserts to tubercles of transverse processes of C1-C3 or C4 vertebrae)

     Deep extrinsic shoulder muscles and superficial ones are all universally known ones. They include levator scapulae, rhomboid major and minor, trapizius, latissimus dorsi.

      Scapulohumeral muscles include deltoid, suprapinatus, infraspinatus, teres major and minor, subscapularis. All these muscles are quite easy to remember.

     Muscles around the arm: biceps brachii, brachialis, coracobrachialis. Extensors: triceps brachii, anconeus (lateral epicondyle to lateral surface of olecranon and superior part of posterior surface of posterior surface of ulna). For the anconeus, besides as an extensor muscle, it also pulls the capsule around the olecranoan of the ulna and humerus away preventing capsule impingement.

      Muscles of the forearm: flexors: pronator teres, flexor carpi radialis, palmaris longus, flexor carpi ulnaris, flexor digitorum superficiali and profundus, flexor pollicis longus, pronator quadratus…..

Diagnosis: usually, besides chest x ray, blood analysis and other biochemical tests, one important part of modern sports medicine that elucidate the diagnosis is Special Tests. With these tests, you can probably know much of your patient’s physical status and your treatment will be more focused. The following part is those tests used quite often in the modern sports medicine field. Note that not all these tests are one hundred percent sure for the diagnosis, and you have to know the specificity and sensitivity of the test in order to have a better idea what the result of the test means to the patient.