Functional test and the empty can test. What is a functional test? What is an empty can test and how does it work? Firstly, functional tests are used to test the strength or load capacity of a single muscle. Secondly, the importance of a functional test is due to avoid misinterpretation of the muscle status and joint health conditions. Furthermore, functional tests can be positive or negative. So, for positive, we refer to a test that gave us the result we were suspicious of. For example, if I do an empty can test, and the client during the test complains of pain in the shoulder acromion, the test is positive. But if for instance, the client complains of pain in another area of the shoulder or arm, the test is negative. Even so, as a therapist, we are aware that other area of the arm or shoulder needs to be looked after. What is an “empty can test”? An “empty can test” is a functional test used to validate the state of health of the supraspinatus tendon, at the high of the acromioclavicular joint. In addition, to better understand how this specific test works, let’s look in too the anatomy of the Supraspinatus m. Origin: Supraspinatus fossa of scapula Insertion: Greater tubercle of the humerus Action: Abduct the shoulder and stabilise the humeral head in the glenoid cavity. As per result, the action of the supraspinatus is to laterally elevate the arm and hold in place the humeral head (the Humerus is the bond of the upper arm). Furthermore, the supraspinatus is one of the rotator cuff muscles. The rotator cuff muscles are: Supraspinatus, Teres minor, Infraspinatus and subscapularis. But let’s get back to the empty can test. The empty can test can be done from seated or standing. In addition, the test is conducted in 2 different stages. Initially, we will ask the client to bring the arm in flexion at about 45° and in abduction at 45°. The arm now is sitting aside from the client’s body, on a diagonal line. Now will ask the client to rotate the arm on itself, as if they are emptying a can. As per the result, if at this stage of the functional tests, the client feels pain in the shoulder at the acromioclavicular joint, the test is positive. If that’s not the case, then we can proceed with the resistant part. If this post is talking to you, and you are in need of a massage, book your next session by clicking here. The resistant part consists of placing our hand on the client’s forearm and asking the client to meet the resistance, at 3 different stages. For each stage, the resistance increases and lasts from 3 to 5 seconds. If during any of the 3 stages the client feels pain, at the high of the acromioclavicular joint, the test is positive. But why the client can feel pain during this type of functional test? To answer this question, we have to look in too the acromioclavicular joint anatomy, but I will talk about this topic in the next blog post.
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Oct
Firstly the Cervical Occipital muscles are a group of muscles, that seat inferior to the skull and are bilateral to the first and second cervical vertebrae. Cervical Occipital muscles are responsible for 45° of rotation out of 90°. Along with these muscles we find: – Obliquus Capitis Inferior; Origin: Spinous process of Axis (C2) Insertion: Transverse process of Atlas (C1) Innervation: Suboccipital nerve – Obliquus Capitis Superior Origin: Transverse process of Atlas (C1) Insertion: Superior line of Occipital bone Innervation: Suboccipital nerve – Rectus Capitis Posterior Major Origin: Spinous process of Axis (C2) Insertion: Inferior line of Occipital bone Innervation: Suboccipital nerve (posterior ramus of spinal nerve C1) – Rectus Capitis Posterior Minor Origin: Spinous process of Atlas Insertion: Inferior Line of Occipital bone Innervation: Suboccipital nerve The actions supported by Occipital Muscles are to extend and rotate the head. How tight Occipital Muscle affect ROM. When rotating the head, so looking at your right or left, you may notice that you don’t have a full range of 80° to 90°, and you start rotating with the thoracic too. One possible reason for this is tension at the occipital area, due to muscle tension and or facet joint irritation. Moreover, to the rotation and extension actions the Cervical Occipital Muscles, are responsible for holding the head up straight. This characteristic is to be taken into consideration with the anti-gravity functionality. In addition to the Cervical Occipital Muscles, other anti-gravitational muscles are the Soleus, Quadriceps Femoris Group, Gluteus Max, and Erectors Spines group. The anti-gravity functionality is essential for the body to fight back gravity (9.81 m/sec2) and allows the body to stand straight up. This group of muscles received information in regard to the gravity pressure from the feet. This information travels along the nervous system starting from the Center of Gravity (COG) of the feet. If the COG is not balanced all body gets affected with a loss of balance as per result. Furthermore, in modern days, the Cervical Occipital Muscles are under constant stress as per all the other anti-gravitas muscles. This is due to spending long hours standing or seating. For example, standing for long hours would overload the feet, leg and back muscles, whereas seating would inhibit the leg muscle but overload the back and cervical muscles. On top of that, spending long hours looking at the phone and or PC would additionally put stress the Cervical Occipital Muscles muscles, as they get over-stretched. How massage can help? As per massaging this area, as therapists, we look into avoiding the Suboccipital triangle, which is defined by the border of the OCI, OCS, and the RCMaj. The Suboccipital triangle is an endangerment site. This means contains superficial, delicate structures that are relatively unprotected and therefore prone to injuries, such as the Vertebral artery, Suboccipital nerve (C1) and Suboccipital venous plexus. If this post is talking to you, and you are in need of a massage, book your next session by clicking here. And what about exercises? As per all the muscles of the body, there are exercises that can be done for the Cervical Occipital Muscles. Along with Thai Yoga, I teach a really simple exercise that recalls the Scap Off Load Test ( a Functional test used to determine what muscle of the cervical region may affect the head rotation). Firstly, in this exercise, available in the Melbourne Massage and Treatment YouTube playlist, you are seating on the floor with a cross leg (a yoga block or pillow can be used as per support), hands projected backwards, with wrists seated below shoulders on a straight line. As per result, the neck would seat in between the shoulders. Secondly, by flexing the head forward, reach the manubrium (the bond that connects the clavicles) with the chin, and with a gentle rotation movement, start rotating the head in a circular movement. Indeed per many Thai Yoga exercises, it is important to be aware of the movement, the body sensation and the speed of movement, which is to be slow and weighted out.
Sep
Scoliosis is a sideways curvature of the spine that most often is diagnosed in adolescents. Firstly, let’s say that there are 2 main types of scoliosis: Functional and Structural. Indeed, Functional S. is a type of scoliosis due to a muscular unbalance in the body. The spine presents a curvature but no rotations. On the other hand, Structural scoliosis is due to a structural abnormality, like a bond deformation along with the skeleton and it diverges from a functional S. due to rotation in the spine, and not just a curve. Said so, to diagnose the differences between functional and structural, we can ask the client to band forwards from a standing-up position, by trying to reach the floor with the hands. As the client band forward, if there is torsion in the torso, that’s a sign of structural scoliosis. About 80% of scoliosis, is structural. There are then different levels of scoliosis: Mild Cobb angle measurement of between 10 and 25 degrees Moderate: Cobb angle measurement of between 25 and 40 degrees Severe: Cobb angle measurement of 40+ degrees Very severe: Cobb angle measurement of 80+ degrees The Cobb angle is the most widely used measurement to quantify the magnitude of spinal deformities, on plain radiographs. Scoliosis is defined as a lateral spinal curvature with a Cobb angle of >10°. Furthermore, the different levels of scoliosis can be defined as: Idiopathic This is the most common type of scoliosis and as it doesn’t reproduce any pain at a young age, it is often missed diagnosed becoming the cause of pain in the adult stage of life. It does affect more women than men. Are you struggling with pain and or body ache? Book now your next massage appointment at Fitzroy North Clinic. Neuromuscular As per the name, in this case, scoliosis is associated with neuromuscular issues. Often it is diagnosed at a young age, and the 2 conditions have to be treated separately. Degenerative As per the name, this type of S. is due to a bond degeneration at the level of the facet joint. As per the result, the symptoms are like: lower back pain, (that’s where most commonly a degenerative facet can happen), sciatica pain, and difficulties in walking. Congenital Congenital scoliosis is a condition that affects a child that is not born yet. As the fetus is forming, one or more vertebrae may fuse together, or bony spinal segments or vertebrae fail to form properly. Traumatic Traumatic scoliosis, as the term already described, can be the result of an accident or a major physical trauma. Like a car accident. Given now a clear explanation of this condition, we are a bit more aware of what a curve in the spine is about. Corrective exercises are the key answer to scoliosis. Physiotherapy is probably the best medical practitioner to refer to for corrective exercises related to this condition. Said so: Q: “I got lower back pain. That means I got scoliosis?” A: “No. Lower back pain is one of the symptoms of scoliosis, but there are several reasons why you may suffer from lower back pain.”
Sep
The Lower Cross Syndrome as for the Upper Cross Syndrome is an unbalance between the forces of muscle groups that cross each other between the anterior and posterior of the body. For Lower Cross Syndrome, we look into the Pelvic area. The pelvis’s role The pelvis acts as a hinge between the upper and lower limbs. It is made from a group of bones, ilium, ischium, sacrum, and coccyx interconnected by ligaments. The pelvis is constantly under the force of pressure or force of pull, which either comes from the upper limb or the lower limb muscle group. Said so, we have to point out that, between women and men there is a difference in pelvic shape. The women have a more rounded girdle than men, this is obviously for evolutionary reasons, due to the fact the woman gives birth. Furthermore for a woman is more common to have a wider range for Anterior pelvic tilt. For Women is acceptable an anterior pelvic tilt between 1 and 2 cm, wherein man it should be up to 1cm. This is because of the girdle shape. In fact, when we look into the pelvic level from the side point of view, we expect to find an anterior pelvis tilt, that doesn’t take over the parameters mentioned above. This anterior pelvis position, allows the lumbar spine to be slightly arched, so that it can better take the pressure, without the risk to create injury to the lower back. How to measure the A or P pelvic tilt? To do so we look sidewise at the difference in high between the ASIS (Anterior Superior Illica spine) and the PSIS (Posterior Superior Illiac Spine). As the L and R sides of the pelvis are independent of one another one, we can find a dissociation in the tilt of the opposite side. That means that L can be anteriorly tilted and R. posteriorly tilt, or vice versa. Moving on, now we can analyze what muscles are involved in Lower Cross Syndrome. For an Anterior Pelvic tilt, we look into tensions for this group of muscles: Erector spinae group Iliopsoas muscles Rectus Femoris Are you struggling with pain and or body ache? Book now your next massage appointment, at North Fitzroy clinic. For a Posterior Pelvic Tilt, we look into tensions for this other group of muscles: Gluteus Max Hamstring Rectus Abdominus External Oblique As one or the other group of muscles is tense, the other one as consequence would be weaker. For example, a person that drives for long hours, or an office worker would commonly suffer from an Anterior Pelvic tilt from Lower Cross Syndrome. That’s because their Psoas is in constantly forced contraction (hip flexor) and the hamstrings are constantly weakened from the long seating hours. So when I treat someone with Thai Massage, before the treatment I always make sure to analyze the pelvis level. This would instantly give me an idea of the balance and unbalance that the person eventually suffers from. The work that I would do for this type of dysfunction involved the relative muscles, mentioned above, but not only. During the Thai Massage, as the client lying on a side position, to access areas like the back and or gluteus, I would also work on the client’s shoulders. If initially, I would not work on the shoulders, after a few minutes the client will find discomfort in the area. What I like about this Thai Massage technique, is that is not demanding on my body and give me a wider range of access to the client’s body. Because I can use my feet, knees, elbows, and hands to give a massage, I can freely change the type of pressure to the client’s needs. Whereas if I was working with a Remedial Massage, the limitations are broader. Working with a table would make it much harder to access certain body muscles. Furthermore, it would be hard if not impossible to use feet or knees for massaging.
Sep
The Psoas Muscle. The Psoas muscle is a muscle that seats in the Lumbar region of the body. It is palpable through the abdominal region when the client is in the supine position. Psoas Muscle is often related to and taken into consideration with iliacus muscle, as those 2 muscles share the insertion tendon and point. For this reason, they get called Iliopsoas Muscle. Origin, Insertion, and Action of the Psoas Muscle: Origin: Body and Transverse process of the Lumbar Vertebrae (L1-L5) Insertion: Lesser Trochanter of the Femur Action: with the Origin fixed: flex the hip externally rotate the hip with the Insertion fixed: flex the trunk towards the tight tilt the pelvis anteriorly flex the vertebral column laterally. Innervation is supplied from the anterior rami of spinal nerve L1-L3 Blood Supply from the lumbar branch of the iliolumbar artery The Psoas muscle has a reference pattern that involved the abdominal area but even the front of the tight. It is often tight for people who spend a lot of time seating on a chair, like office workers and or who drive for long hours. This happens because the muscle is in constant contraction when we spend time seating. On the other hand, the Psoas Muscle is often also related to emotional distress. This can happen because when we live with negative emotions we tend to contract the abdominal area and tight the muscle-up, especially for reaching out a fetal position, which recalls maternity safety. By analyzing the action of this muscle, it is easy to notice how is involved in assuming a fetal position, as it is a hip flexor. In fact, it contracts the 2 limbs, the upper and lower to gain one with each other. Treating the Psoas Muscle directly is not always recommended as direct work unless the person has been going through a series of treatments already. This is because where the muscle is lying it is a sensitive spot to access and as it holds a lot of tension, can be a bit sensitive to the touch. In need of a massage? Book now your next appointment, at Melbourne Massage and Treatment clinic. To treat the Psoas Muscle the client is lying in a supine position. Firstly we identify the muscle. For doing so after the client did lie in the supine position, the therapist will place her/his hands off the rectus abdominis, on its lat. border, and will create resistance on the client’s tight as it goes for active flexion. With the hand seating next to the rectus abdominal area, the therapist can feel the muscle activating. Once the Psoas has been isolated, the therapist can place both hands or one on the muscle, asking the client to breath-in deeply as is flexing the knee (foot running along the table) and as the client’s breath out (it is important here following the breathing wave) the therapist can apply a force straight down. Furthermore, to ensure that we can release tension from the Psoas Muscle, we have to work on the muscle surrounding it, like the other muscle that holds the same Origin/Insertion patterns, like: Erectus Spinae group, Quadratus Lumborum, Quods Hamstring In fact, the psoas muscle can be involved in presentations such as lower cross syndrome (LCS). Are you struggling with pain and or body ache? Book now your next massage appointment, at Fitzroy North clinic. Often as therapists, we would work on the surrounding muscle before doing direct work on the Psoas. This is because direct work in such a sensitive area can be too intense to start with and could make the client feel vulnerable or uncomfortable. A good exercise to keep the Psoas muscle in shape is a daily walk, even though for a nice and balanced walk we want to make sure to have a correct Extension Leg Firing Pattern.
Aug
Muscle Firing pattern Muscle firing pattern is the sequence in which muscle should get activated to complete an action or movement. Whenever we move a joint, is not just 1 muscle to do that action there are multiple numbers of muscles that allow the action to happen, and other multiple numbers of muscles counterbalance that action. So, the muscles that control the action are called agonist muscles and the antagonist are the muscles that counterbalance that action. The antagonists are usually the muscles that do the opposite action to the one played. Said so we have also to introduce another term, that in the massage industry is known as synergetic muscles. Synergetic muscles work together to make allow a joint to complete an action. But let’s look into an example. Leg extension firing pattern. Leg extension is controlled by the synergetic muscle: gluteus max (GM) hamstring (HM erectors spine (Esp o) (opposite side of the leg) erectors spine (Esp s) (same side of the leg) The antagonist in the leg extensions are the Quadriceps. So, let’s focus on the agonist of this action for now. If the GM is weak or inactive, when we go for leg extension the Hm gets overpowered. As the Hm gets overpowered the ES starts firing too early to stabilize the pelvis abandoned from the weakness of the gluteus. Moving forward with this unbalance, the ES on the same side could end up to start being the first muscle that gets fired for doing the action of leg extension when it should be the last one. And this could happen because the Esp o is holding the body still to get the action done. Lower back pain or hamstring tear can be often a consequence of these unbalances. Lower back pain can happen when the firing pattern is like: 1st Erectos Spine (opposite or same side) 2nd Hamstring 3rd Gluteus Max (because if weak or inactive) Hamstring tear can happen when the firing pattern is like: 1st) Hamstring 2nd) Eroctos Spine (opposite or same side) 3rd) Gluteus Max (because if weak or inactive) But nothing is lost, and the firing pattern can be reorganised. For doing that we have to look into exercises for firing pattern reestablishment. For the leg extension, for example, the exercises would be: Lying in a prone position (face down) Tugged the toes under the feet Squeeze the gluteus one against the other With the gluteus, squeeze and extend the knee Still with the gluteus squeezed to release the knee The final step, release the gluteus. Repeat 30 times for 6 weeks every day. To don’t fall back into an incorrect firing pattern, make sure to strengthen the gluteus. Massage would help to release the trigger point in the GM. Thanks to the release of trigger points the muscle can start to be trained to get stronger. Are you struggling with pain and or body ache? Book now your next massage appointment, at Melbourne Massage and Treatment. Also, massage can help in fastening the process of firing pattern reestablishment, by reducing tension in the hamstring and or reducing pain in the lower back by flashing out the tensions that have been accumulated over time.
Aug
Lower Back Pain Lower back pain is a condition which can deliver lots of stress and can affect our daily habits. It can be a terrible experience to live, as it can make many tasks difficult or impossible to take. Here below you will find a series of questions and answers in regard to my experience with lower back pain, as a person and as a practitioner. Q: Did/do you ever experience lower back pain? A: Yes, I did suffer from lower back pain when I was a teenager and that was a trigger for my massage career.Said so, at the age of 16, I was not thinking yet to become a massage therapist.More experience was needed before I did decide to step into the massage career. Q: How common is lower back pain within the Australian population? A: It is estimated that in Australia between 2017 and 2018 4.0 million people did suffer from back pain, whereas 70-90% out of those 4 million did suffer from the lower back itself. Q: What are the causes of Lower back pain? A: Lower back pain can come from different causes. Here below are the most common: bulge disk muscle strain fascia tightness trigger points muscular-skeletal unbalance physical trauma stress Q: I feel pain on my Rx or Lx side on a horizontal line. What can be? A: That’s what we call a red flag. A pain that spread on a horizontal line can be given by a bulging disk. More tests must be put in place to confirm a diagnosis. As a massage therapist is not in our scope of practice to diagnose a bulging disk. Our next step would be to refer you to a GP for further investigations. Q: So, what is a bulging disk? A: A bulging disk is a condition (hernia) where the disk that seat between the vertebrae, gets a tear in it. As a consequence, the disk touches the nerve running along the spine and creates a pain sensation. There are 4 different stages of herniation of the disk. Disc protrusion Prolapsed disc Disc extrusion Sequestered disc. Q: What are other symptoms related to a bulging disk (for the lower back)? A: Other symptoms of a bulging disk (for the lower back) can be: Numbness in the glutes, legs, feet. Weakness in the leg/feet movement Pain increases when seating, like the disk, gets compressed and decreases if standing, like the disk, gets decompressed and less pressure is applied to the nerve root. Difficulties in going to urinate, it is a strong sign that there could be a bulging disk in the lower side of the lumbar area. Medical attention is urgently recommended. Q: Why a bulging disk can occur urine blockage? A: The nerve that controls the spasm of the bladder is rooted between L1 and L2. Indeed, Pressure on the main root, between these 2 vertebrae, would then transform into nerve dysfunction. This condition is called Cauda Equina Syndrome. Q: My lower back pain moves vertically. Why is that? A: A sign of lower back pain that moves vertically is more luckily related to muscular inflammation. In fact, there is a group of back muscle called Erectus Spinae, (Spinalis, Longissimus, Illiocostalis) that originates in the lower side of the lumbar area and extend vertically along the cervical area. Q: What triggers muscle inflammation? A: Many are the reason why muscles can get inflamed.Repetitive movements pour posture, the incorrect firing pattern of a muscle group, in specific the leg extension firing pattern. Q: How massage can help? A: Massage can be an effective approach to release tension along the lower back. Given the training that I did go for, I would ensure to use the knowledge learned along the Remedial Massage and Myotherapy course to identify what back pain is related to. Based on the finding and on the willingness of the clients, we can then disgust with the client what technique of massage they may prefer, Remedial Massage, Dry Needling (if applicable), Mobilisation (if applicable) or Thai Massage. Even MLD can be an effective technique, as it can be used to reduce inflammation, swelling, tension and stress. As previously mentioned, if I got suspicious of a bulging disk, I would not hesitate to refer the client to a GP for further investigation. In regards to the Thai massage technique, I will ensure to warm up the area first with some simple passives stretch and or cupping and then work on the muscle that needs some tension released if it is safe to do so, or on the muscle surrounding the area, like gluteus, hamstrings and or shoulder muscles. Q: Would you use your knee to massage my back? A: The use of the knee is not compulsory. If it is safe to do so, yes, I may use my knee to massage the back. A correct and proper evaluation of the injury must be applied before doing so. If you are in pain or even just feel tight along your lower back, don’t hesitate to book a massage appointment. Any of the techniques offered at Melbourne Thai Treatment can be really effective in reducing pain and ache and giving you back the mobility lost. Said so, for chronic conditions their massage can help till a certain point. Exercises and other treatment options have to be evaluated.
Aug
The importance of breathing. As a massage therapist, I realise along with my studies and work-practice, that correct breathing is not something that many of us are aware of. Indeed, breathing is important to oxygenate our organs, muscle and all body parts and also, breathing is what would boost the healing process along a massage session. In fact, when we breathe, we introduce into the body Oxygen. Oxygen is what our body uses as the first form of energy for functioning and self-healing. Furthermore along with oxygen, when we breathe, there are a lot of other substances that get pumped around the body with the blood, like vitamins, minerals, hormones etc. So how should we breathe, during a massage session? To breathe we can mainly use the noose and the mouth. By breathing by the nose we partly clean the air that we take in, things that wouldn’t happen when we breathe in by the mouth, as we would breathe whatever is in the air. If this post is talking to you, and you are in need of a massage, book your next session by clicking here. But that’s all? No. Air inhaled through the nose is both warmed and made moist at the same time, but also preserves oral hygiene. Furthermore, breathing in with the nose is a slower process and helps the mind to stay calm and grounded. Breath-in by the mouth can lead to hyperventilation, that’s a cause of stress and or a response to panic and anxiety. The mouth is part of the body that we should use to breathe out. As we breathe out we want to let go of all the air that we inhale without interruption. So, a better way of breathing would be, to breathe in through the nose and out of the mouth. But where into inhaling the air that we breathe? This is a question that we will see in the next blog post that would talk about the breathing wave exercise, an essential technique to calm down the mind, regulate blood flow and stimulate the relaxation of the nervous system.
Jul
What is, Upper Cross Syndrome? Upper cross syndrome (UCS) is a common posture imbalance that affects many people nowadays and it is caused by repetitive poor posture habits. The body‘s muscles work in coordination with another one to keep our posture erected along the Plumb Line. The Plumb line is an imaginary line that runs from the top of the body down to the foot, passing by the: Mastoid process of the skull Middle Acromion (shoulder joint) Centre of gravity of the body (pelvis) Greater Trochanter (GT or Head of the Femur) Side of the Knee Down to the Malleolus. The head and shoulders are protracted compared to the plumb line, for someone that suffers from UCS. This happens when there is an unbalance between the anterior and posterior portions of the cervical area. So, to better understand what UCS is, let’s go through which muscles are involved in this condition, and the muscle’s role. Let’s start by drawing a diagonal line from the shoulders down to the upper chest area of the pectoralis (). The diagonal line would cross first the Upper Trap (UT) and Levator Scapulae (LS) for then cross the Pectoralis Major (PM). What do these muscles have in common? Tightness. The tight pectoralis would protract the shoulders. On the other hand, UT and LS would elevate the shoulders and scapula and accentuate the shoulder protraction. Indeed, this force applied bilaterally would place the muscle that is attached from the spine into the Scapula (or Shoulder Blade) under constant stretch, as for the muscle that keeps the neck erect, like the Deep Flexor Muscles (Longus Colli, Longus Capitus, Rectus Capitus and Longus Cervicus). Do you feel like you need help with your neck pain? Book now your next appointment, at Fitzroy North clinic. Now let’s draw a second diagonal line, in the opposite direction of the first one . This line would start from the anterior side of the body. From the neck area and go towards the posterior inferior side of the body. Therefore, would cross first the Deeper Flexor Muscles of the neck and then the Rhomboids (RH) and Middle Trap (MT). What this muscle got in common? As mentioned before because those muscles are placed under constant stress, they get weak, and can’t hold the neck and the scapula in place. How massage therapy can help? Massage therapy is a great way to create balance in the body structure. So, along with a massage session, either Thai Massage, Remedial Massage and or Myotherapy, we would start by doing a series of postural assessments and Range of Motion (ROM). This would allow me, the therapist, to pint point out what muscle needs more attention, and if there is more presentation to add to the UCS. From there then, we may start working on releasing tension from the Pec area and the UT, using gentle strokes that involve stimulating blood flow and heat in the area. Where per areas like rhomboids we would use techniques that may recreate some pain, so to stimulate the muscle to be activated. Said so, depending on the massage therapy I am offering, the approach can be slightly different. In conclusion, there is to say, that massage therapy by itself, would not be enough, if the person, at the end of the treatment, would go back to their routine life. It would be important that the patient follows the exercises that they would give at the end of the massage session. Exercises for UCS