Clinical Massage Therapy by Rattray and Ludwig
Therapist Recommends: The BEST all-around reference for your massage therapy practice.
Clinical Massage Therapy is based on the 2,200-hour Ontario treatment-based curriculum. It is designed to be used either as a textbook for students or a reference for practitioners. Extensively researched, the book’s treatment sections are organized around treatment guidelines (including boundaries, assessment, self-care) foundations (including stress reduction, pregnancy, edema), and five strategies pertaining to various conditions (inflammatory process, overuse injuries, fascial and muscle imbalances central nervous system conditions, crush and severance injuries to peripheral nerves).
With more than 1,100 pages, Clinical Massage Therapy is virtually encyclopedic. Rather than producing a second edition of Rattray’s first excellent book, Massage Therapy: An Approach to Treatments (1994), the authors created this book to stand alone as a totally new publication. And it is huge – the Manhattan phone book of massage texts.
Like most textbooks, it begins with a brief history of massage. An overview of current research and explanations of the general effects of massage organized by systems, follows this chapter. Chapter 3 details Swedish massage techniques, including effects of specific strokes, contraindications and lubricants. The illustrations are somewhat stiff but clearly instructive. Chapter 4 discusses “non-Swedish” techniques: Manual Lymph Drainage; Static Pressure Techniques; Cross-fibre Frictions; Fascial and Connective Tissue Techniques; and Joint Mobilization Techniques. The authors’ descriptions of each technique are concise, serving as a conveniently organized reference for advanced therapists as well as an introductory menu for students.
In Chapter 5, the authors discuss the principles of sequencing, showing how to integrate various techniques into a cohesive, logical massage treatment session. Chapter 6 defines hydrotherapy. Remedial, or rehabilitation, exercises are described in Chapter 7, including on designing self-care programs of clients.
The section entitled “Establishing the Guidelines for Treatment” includes discussions of boundary issues, therapist/client communications, and assessment, including creating SOAP (subjective, objective, assessment, plan) notes, taking health histories and testing range of motion. Pillowing, positioning, and draping are followed by an essay on palpation and principles related to working with clients’ tissue, including a somewhat convoluted exercise for increasing palpation skills.
Chapter 13, “Contraindications and Modifications for Specific Conditions and Medications,” presents an overview of general concepts. Subsequent descriptions of particular treatments give more specific contraindications. Rattray presents valuable introductory information on massage and medications in this chapter. Chapter 14 presents a detailed discussion of the physiology of stress, and the importance of massage therapy as a preventive treatment for stress-related conditions.
In Chapter 15, Ludwig defines pregnancy as a “state of wellness associated with many interrelated changes that occur throughout the woman’s body as the fetus develops” (p. 177). Ludwig lists general characteristics of the three trimesters along with positioning concerns (for example, side-lying on the left side, if necessary, to ease pressure on the aorta and vena cava), and appropriate massage techniques for hyperlodosis and for compression syndromes. Following this chapter are chapters on the physiology and treatment of spasm, myofascial trigger points and edema.
The bulk of the book is dedicated to the five strategies noted above and various general topics of specific conditions related to each one. In the chapter, “Massage and the Inflammatory Process,” the inflammatory process is defined as “a necessary step towards the healing of injured tissue” (p.233) Types and stages of healing, along with treatment considerations and goals, are followed by chapters on scar tissue, wounds and burns, contusions (i.e., a crush injury to a muscle), strains, sprains, and then injuries of the joints. In a logical progression, fractures come next followed by the complicated subject of whiplash.
The next strategy concerns overuse injuries, including tendinitis, bursitis and frozen shoulder. Head, and neck conditions are described next, including torticollis and tension headaches. Rattray deals with migraines in detail. “Strategies for Fascial and Muscle Imbalances” comes next, covering various postural conditions with anatomy, symptoms, assessments contraindications and treatment plans. This is followed by conditions of hypermobility and hypomobility, including temporomandibular joint (TMJ) dysfunction, degenerative disc disease and osteoarthritis. Again, in a logical progression, strategies concerning central nervous system conditions follow.
At this point, the authors insert a chapter on communication skills regarding disabled clients, avoiding negative stereotypes and developing facility with appropriate medical terminology. A chapter on ambulation aids supports the preceding chapter with very useful recommendations for client observations and therapist body mechanics when treating clients in wheelchairs. Information on decubitus ulcers, seizures, hemiplegia, multiple sclerosis, Parkinson’s disease, cerebral palsy and spinal cord injury follows.
In the section entitled “Conditions of the Peripheral Nervous System,” lesions to specific nerves and compression syndromes are discussed and supplemented with detailed illustrations. Respiratory pathologies, circulatory pathologies and dysfunctions, and gastrointestinal concerns follow. Finally, “Systemic Concerns and Other Conditions” round out this tome, including inflammatory arthritides (i.e., gout, Lyme disease, rheumatoid arthritis, and more) fibromyalgia and chronic fatigue syndrome, osteoporosis, diabetes, various forms of cancer, and HIV/AIDS.
The five appendices include orthopedic assessment, visceral pain patterns, and skin pathologies. I cannot think of anything that was left out of this massive reference work, and I think that every massage therapist who owns a copy will refer to it almost every day. My only complaint is that it’s too big to carry around from home to school of to various workplaces. The page design is spread out with larger type sizes, which makes it easy to read. Publishing this book was a seriously ambitious project, and the authors succeeded in creating an enormous contribution to the literature.