Heidi's case study

My client is 26 yrs old, 6’2 and is active and eats healthy. He has been a mechanic for 7 years. Client clams his job requires him to put his hands and body in to cramping positions. He clams of pain in both forearms, lower back, both shoulders (upper traps and rhomboid area), and that his hands will freeze up often, when this occurs he has to stop his work till he can move his hands again. which could take anywhere from 5-60 minutes.

The first massage was a relaxation massage with additional time spent on both arms, working the LI pain path. I noticed that his lung 9-10 acupoints were rock solid. The client states his hands didn’t freeze up for over a week. Used to happen 1-2x a week.

Second massage was similar with the back shu points added in. LU and HT shu points were tense and tender.

After this I formed a treatment for him involving guasha, bladder opening pattern [modified tui na massage], and working the LU and HT shu points and meridians down arms. Po Sum On is added to the treatment with success. 

As a result of the treatment the client’s hands have not frozen up on him, there is less pain in his forearm and he knows how to stretch them correctly. His energy level has increased and generally feels better. He is continuing massage weekly.

Six Week Journey

When I asked my sister if she wanted to help me with massage school, she didn't know what she was in for.  I explained that each student needed a case study, "Huh?"   A hands on experience, working with the same client to try and help with a chief complaint.  I told her the plan was to give one massage a week for six weeks.  She said she might be able to tolerate something like that.

I then came to know my sister in a whole new way.  She told me all about an experience she had in Oregon.  She woke up in the middle of the night, blood streaming out of her nose.  Jumping to her feet she noticed that her low back was spasming.  Waking a roommate to take her to the ER, she went to the restroom to grab something to staunch the blood flow   She next woke up on the floor, inches away from the cabinets under the vanity.  The ambulance was called. After a gurney trip to the ER, she was released with a clean bill of health.  She told me that she would really like to not feel faint anymore.  Not to be afraid of another night like that one.  In true Taoist fashion I gave the confident "I can help with that."

Learning a little about Traditional Chinese Medicine from the advanced classes in school gave me tools to put together a treatment plan.  I thought it would be best to do a series of three general relaxation massages, followed by more specialized treatments specifically to balance the water element.  This element jumped out at me from what she said about being afraid of fainting.  In Chinese Medicine fear is closely associated with the water element.  Armed with this as an overarching scheme, I hoped to add on more techniques as I learned them.

I was delighted to find out that my client was also planning to see an acupuncturist.  The treatments complimented each other nicely.  I noticed that in the massages just after her acupuncture she felt much more "open." Four weeks into treatment she confided that she no longer felt like fainting.  I noticed a shift in things at this point as well.  Many more lively happy days, a drive to eat healthy and exercise more.  An overall brightening of outlook on life.

To balance the water element I used an extended version of a pattern I had learned in school.  The Bladder meridian opening pattern.  This Tui Na flavored massage emphasizes warming the low back and balancing the entire body via the organ acupressure points on the back, known as the Shu points.  I also integrated an essential oil blend to help warm and boost immune function.  I used a mix of Ginger and Hyssop oils applied to the back in a carrier oil.  After the oil treatments the client always felt "great"

The six weeks had flown by.  My client was showing excellent improvement that I attribute to the acupuncture backed up by the balancing massage therapy.  In short, receiving massage on a regular basis seems to have many benefits.  This experience gave me a chance to observe them first hand.  My client reported: better digestion, more energy, less knots in back, generally warmer. improved mood, relaxed state carrying over into working life.  She plans to continue to receive massage and to enjoy its wonderful benefits.  And as for me, I am encouraged to grow as a therapist. I plan to learn as much as I can about how to help others, and myself, along life's journey. Namaste

Betsy's Case Study

Summary

My client was diagnosed with Multiple Sclerosis in September 1996 at the age of 35 and had no prior symptoms before this time.  She had to have a lumber puncture/spinal tap to rule out a brain tumor.  The puncture didn’t seal correctly and spinal fluid began to leak.  This situation put her in the hospital for a longer stay and when she left the hospital, she was no longer mobile and resided in a wheel chair for 3 months.  Through extensive therapy she was able to walk unassisted in the Spring of 1997 and in the Fall went back to work.

In 2001, she began receiving Acupuncture (5 Elements) and has had over 250 treatments to date. In 2004, she decided to stop all Western Medicine drugs and have had no further MRIs. Since that time, she feels that her health gotten better and the number of MS relapses have definitely decreased.  She now sees a general physician specializing in alternative medicine, a chiropractor, and receives massage once a month.

When my client heard that I was doing a case study,  she asked if she could be the person.  She was interested in receiving massage more often to see what may happen

with her health. 

Her Qi on left side normal, strong, easy flow.

Her Qi on right side heavy, right hip joint achy, right leg feels heavy.

Treatment Plan

Massage weekly

Essential Oil Blend with Spinal application 5 days/weekly: Base - Sweet Almond-Hemp Oil.  In addition to the base, 4 oils are mixed -  Neem, Spikenard, Cardamon, Peppermint and Frankincense

Focus - Qi flow from spine out to shoulders, down arms and legs.

  Qi flow from spine, down back to hips and down legs.

Implement Liver, Kidney, Spleen, Stomach, Gall Bladder and Bladder Meridian Patterns on the legs, focusing emphasis on Kidney and Stomach Meridians.

Effects of Massage

The first two weeks massage was given two times per week but it was to taxing on the client’s body because of the Multiple Sclerosis.  Client enjoyed have the massage twice a week for muscle tension and relaxation but weekly seemed to be better to keep the Qi in balance.

Client’s body responded well to the essential oil blend.   When the essential oil blend was first applied, she felt tingling down her spine.  The blend was applied regularly  over the next two months. Application wasn’t as regular the next few months due to her work/travel schedule.

When receiving massage weekly, the client mentioned that her core felt stronger, her chest area felt more open and in general, her health was better.  As the client was traveling out of state with her job often, she was only able to receive massage monthly.  At this time her right leg was noticeably more swollen and the Qi had difficultly moving.  The client is back to receiving massage once a week and her body is responding positively.    

Massage and Traditional Chinese Medicine

Case Study

2/11/13

I chose my client because he has low back pain, as many people do.  During the interview, he expressed that he is mostly sedentary, drives a truck all day and only exercises when taking his dogs for a walk.  He carries stress in his neck and low back and has been experiencing bouts of low energy and cold feet.  Over the next couple of sessions he later expressed that he has many ideas but had a problem getting the motivation to start them (will power) and also mentioned that he wasn’t sure what he was doing with his life and couldn’t seem to figure out what career path to follow (purpose).  These concerns in conjunction with low back pain and low energy levels immediately made me think of the Water Element.  Then my client actually said, “I feel like water, just going with the flow of life and taking the path of least resistance.”  At this point it was clear that we would be working on his Water Element.

Over the two months of the case study I gave him relaxation massages that lasted between one and two hours that included deep tissue techniques.  I also incorporated the Bladder Meridian Pattern – working the scalp, the Shu Points on the back, and the legs and the Kidney Meridian points 1-9.  I asked the client to do a couple of stretches for the low back at home, daily if possible. The first stretch is to lay down on the floor with one leg straight, the other leg is bent at the knee and laid over the straight leg, and the arm on the side of the straight leg can be used to help keep the bent leg down, turn head towards the straight arm.  The other stretch is to lie on the floor, bend knees to chest with arms around the knees/shins, and roll side to side.  To reduce stress, I asked my client to try relaxation breathing.  Sit in a chair (since it was difficult for him to sit on the floor for long periods) and breathe in through the nose and into the lower abdomen (Lower Dantian) slowly and slowly exhale through the nose while relaxing the shoulders.  Eventually he incorporated a couple of Qi gongs – Mixing Fire and Water and Reaching for Heaven and Earth (seated in a chair at first and eventually standing).

By the end of the case study my client’s low back issues as well as overall stress levels had dissipated. Energy levels have improved as well as his blood circulation.  He even found a job that he actually enjoyed!  I look forward our continual work together.

Case Study

• Male
• 28 years old
• Biologist
• Very active
• Eats  healthy 

I did 7 massages with my case study. He said that his chief complaint was pain under his right occipital bone that radiates down right side of neck and down into the traps. Client said that he hurt it while he was lifting rocks at his cabin in June 2012.

Our first massage was a general relaxation massage. During this massage I noticed that he could barely turn his neck to the right. The pain would shot all the way to his traps. By the end of the massage the client was able to move his neck and said his pain level had decreased.

I spent a lot of time working his neck and traps. Client likes deep work on his traps and along neck. After our first massage I started to design a treatment plan that consists of Range of Motion, yoga stretches, Cupping, Gua Sha and Acupressure points.

I believe that his pain is coming from his SCM and Inferior Oblique Capitis. I thought of these two muscles because of where the client showed me where his pain was. SCM muscle is often tight at the start of each massage but by the end it is lose and client says it stays that way for a few days.

Client responded very well to the Bladder meridian opening pattern [modified Tui Na massage]. Client said that every time we did the BL opener his pain was almost gone half way through the massage. 

The first few times I did Gua Sha on client  it showed up almost black which means the stagnation of the blood has been there for quite some time. Cupping brought up heat and odd marks every time but the last massage.

The first few sessions that we did stretching client couldn’t keep legs straight to do a forward bend. With daily stretching and ROM client is able to do a full forward bend.

On the last massage there was no discoloration or heat coming from clients’ back shu points. By the end of our case study client said that he no longer had any pain at the time of interview. Client also said that he will get regular massage to obtain the feeling of being pain free and will continue to stretch.

Application of Massage Therapy Project

Introduction
This project is to apply our learning's of massage therapy to help someone and demonstrate the benefits that massage can have on a persons life and health.  For my client I have provided 6 massages all at a length of 1.5 to 3 hours based on their desire at the time over the course of about 10 weeks.

Interview and chief complaint
I first had a interview/discussion with my client regarding their feelings day to day, general likes/dislikes, problems and possible complaints to address.  One of the main things I discovered is the client was very demanding of theirself day to day and because of that has a very high stress level.  Many of their mood changes were based upon work performance and completing tasks.  The client is going through many changes in life at the moment.  Based on this information and our discussion we determined the chief complaint to be stress.

Treatment options
I discussed some of the different massage protocols we have gone over in class and different techniques that may work to help relieve stress.  Over the clients lifetime they have only experienced 2 professional massages so we decided to stick to the general relaxation pattern and make modifications as necessary.  The client did suggest one of their favorite parts to massage was the head, neck and face massage so we decided to extend the time on that.

Procedure
Over the 10 week time period we completed 6 massages all ranging from 1.5 hours to 3 hours.  For all the massages we decided to stick to the regular plan, here and there we made modifications when areas needed more attention.  The desire for a thorough head massage was present through all the massages.  The client requested 3 things most often and those are head massage, abdomen massage and work on the bladder meridian.  After we learned the bladder meridian pattern and I added it to one of the massages the client requested that pattern be in the future massages.  Most notably in the bladder meridian the client enjoyed the foot massage, working the bladder meridian in the foot massage almost instantly put the client to sleep each massage.

Results
Over the course of the provided massages here are the most notable changes the client and I were able to identify:

    Reduced level of stress
    Improved quality of sleep
    Increased activity level
    Improved eating habits
    Improved flexibility
    Increase level of energy
    Reduced irritation from joint in foot
    Faster recovery of pulled muscles

All in all the project was enjoyable and it was great to discover the benefits of massage and help another experience a higher state of well being.

Six Week Case Study

Over the course of six weeks we were given the assignment to massage only one person. We were given this assignment so that we as massage therapists would have the oppurtunity to experience the changes in a single persons body wheather it be muscle tension or any mental as well as physical improvements. I chose to work on a 32 year old licenced massage therapist who for the past couple of years has been experiencing alot of pain around her upper back and shoulder area.

Some of this pain could stem from her spinal/ hip missalignment. since she happens to work for a chiroprachtor she is able to receive spinal adjustments as often as her schedule allows her to. She told me her spine and hips have improved significantly due to the adjustments ,yet she like most hard working massage therapists forget or don't even consider to take time out for themselves. over time all that physical work begins to wear you down physically and mentally. In my first session with her we sat down and went over all her medical history I scanned the form looking for any specific areas that stood out or seemed out of balance. she was very open to the idea of receiving any kind of massage for six days a week. Due to her past massage school experiences she had been exposed to the concept of oriental medicine but they had only touched on the subject very briefly. oriental exercise and medicine had always held her intrest so she was very eager and facinated to learn more about the practice.

On day one I gave her just a general relaxation massage to introduce myself to her body and get a feel for her muscles. throughout the massage I used very long soothing strokes feeling for any areas of tension. throughout the next couple of days I found she was tight and knottted usually in the same areas which was around the neck , trap , and shoulder area. some of the sessions she seemed very down and emtionally distraught, so with her permission I incorporated very calming anti-anxiety accupressure points such as stomach eight and stomach forty. Throughout our massages I tryed to channel very calm, loving, and compassionate energy. I gave her some chi-gong exercises to do to help improve her motivation and open her heart center, such as smiling heart chi-gong she told me she loves that chi gong and does it every morning which helps her to start the day off right. The experience was a very rewarding and awe inspiring awakening to the power of massage. throughout those six weeks her stress and tention areas began to melt away she was able to have the motivation to get up early and workout, and she felt everything about her life had completely shifted in a positive way. In the end she requested that I be her only massage therapist which really filled my heart with joy.

Case Study

(s) My client is a 55 year old female. She's in good shape and eats healthy. She's suffering from migraines and bouts of insomnia. She also claims to get very anxious at times. Her right rhomboid is sore as well as the right shoulder. She thinks she has frozen shoulder and tendonitis on that side. Her main goal is to relieve shoulder pain, stress relief, better sleep, and general relaxation.

(o) My client relaxes easily, partly due to her being comfortable with me and partly because she is looking forward to some quiet time. Her traps, neck, rhomboids and levetor scapulae are constantly tight and dense- these muscles include teres minor, supraspinatus, infraspinatus, and subscapularis. The erector spinae group of muscles down the back always seemed to have knots in them. This was more so on the low back. Biceps in the arms felt a bit more tense in the right arm. The IT band was problematic and tight. Rectus Femoris also tight with knots/ "speed" bumps. I could not do a deep clearing stroke on the legs. Throughout the massages I noticed the right shoulder gained more range of motion and flexibility. The IT band also let up over time. She was seemingly happier and more relaxed. She didnt slouch or slump her shoulders as much as she was before. She also said she felt more energized, pain reduction in the shoulder, and could sleep better at night. It took about 3 sessions to really notice a significant difference in how she felt.

(a) Throughout out time together I made sure to move very slow through the head/scalp massage to relax my client. I taught her 3 centered meditation for during the massages and to use outside of our sessions. On days that her anxiety level was high I would do a nice foot massage first and do some energy work to draw the energy down. When she experienced headaches I would work the pain path in the arms, including points LI 11,10,9, and 4. I also incorporated the S.I points 11 and 12 and L.I 16 all located around the shoulder to help with the shoulder pain. Energy work in the arms to draw the energy out through the fingertips and open up the pathway for the pain to travel out. Lung 1 and 2 were also included into the treatment plan, more towards the end. I used the LV/GB grasping down the legs to open up the meridians. This will help wood imbalance, manifested in the nails being ridged. The upper back got extra attention around the rhomboids and made sure to work S.I 10 on the scapula. Deeper pressure was often applied the erector spinae and focused more on the low back. When shoulder pain and headaches were at a high i would focus more on the arms, shoulders, neck, and back, and skip the legs completely besides compression. All these teqniques seemed to work for my client over time with pain relief and over all sense of well being.

(p) I plan to keep working with this person for as long as I can. I would like to assign and teach some Qi Gong movements to help her low back, which would include: Reaching for heaven and earth, accept the moon qi, and painting the world. Rowing on the lake would also be good for range of motion in the shoulders. I would also like to use the 9 points to revive the yang for depression issues and to restore energy. I would like to draw up a 5 element chart and map out imbalances to help her further. My client is very curious about chinese medicine, and would love to see some more results. I would also like to do a moxa/kidney treatment that we recently learned to help the low back and kidney qi. I will encourage her to use the meditation daily, especially before bed. I would like to practice Smiling Heart Qi Gong with her as well because its my favorite Qi Gong and opens the heart center

In conclusion I would say that I could see a significant different in body tension and some internal changes. Its amazing what a month and a half of consecutive massage can do. I am excited to learn more about Oriental Medicine and use it in the practice. I feel like the things i have learned here at OHAC are beneficial to my practice and make a tremendous difference. They can be life changing and are always positive. I cant wait to see what other positive changes I can make in my life and others.

Case Study

My case study included six massages spread out over a period of nine weeks. Ideally, I would have liked to have seen my client at least once a week, but because of our different schedules and time constraints it took nine weeks to complete all six massages.

My client was a 42 year old female. During the first intake the client told me that she was on blood thinners (Coumadin). In January of 2009 she was experiencing pain in her legs, sever fatigue and dizziness. She ended up in the emergency room and it was discovered that she had many blood clots in her left leg. She was admitted to the hospital and stayed for a week under close supervision until she was stable enough to go into surgery where the Doctors placed a filter in her Vena Cava. The filter was put in place to help catch the clots so they would not go through her heart, into her lungs and cause a possible pulmonary embolism.During this time she was also placed on blood thinners, namely Coumadin, to help prevent further clotting. Her leg gets achy when she is on her feet all day and she has been told to elevate it at the end of the day. She now takes blood thinners daily and sometimes hydrocodone for the pain in her legs. The Dr.’s say she will probably have to be on Coumadin for the rest of her life. Because of the blood thinners she tends to bruise easily. She used to go in for lymphatic drainage massage (usually only the axillary and clavicle area) twice a month but doesn’t do this anymore. She has been cleared by her Dr. for regular massage therapy.

During her time in the hospital she also drastically lost weight. Since then she has had low energy and no regular physical exercise plan and has put on a lot of weight. This makes her upset and sometimes sad and frustrated about her lack of energy. She experiences swelling in her legs after extended periods of being on her feet (walking, standing, ect..) and has had difficulty staying active because of this and stress with kids, work, and everyday life. She has said that when she can fit in regular exercise her leg feels less achy and she sleeps better.
Also during the intake she indicated that she has a medium stress level and holds her stress in her shoulders and low back. She also tends to get very bad headaches when she gets very stressed out. Works in an office and has for most of her professional life.

My client’s main goal for her massage was relaxation. I could tell by the way she spoke and the concerns she had that her thoughts seemed hurried and rushed. Her eyes looked tired and tended to sigh often while she talked. Her skin was healthy and soft, well tanned. Although she had not been doing regular exercise and had gained some weight, her muscle tone was still good and her energy felt strong but tired. She had lots of tension in her neck and upper traps, with a large knot in the left occipitals. She was very sensitive in the neck area. Small bump on palmar side of right forearm (says it has been there since she was young) that could be a possible ganglion cyst. Her left leg was noticeably more swollen than her right from the iliac crest to her ankle, seemed to be more so around thigh area. Edema but not pitting. Feet were both cold and limited ROM in hip area. Some tension in low back and erector spinae and knots in L levator scapulae and R rhomboids. All shu points on back felt good except for small pluckable knot in R LV shu point.

Because of the clients blood thinner medication I used only light/moderate pressure with lots of soothing strokes. She was sensitive in certain places, liker her neck, but liked a little more pressure on her back and so I adjusted accordingly. I spent a good amount of time on face and head massage to open up and relieve tension in that area to help with headaches. I did more detailed work on her neck and upper traps to help loosen and break up stagnant energy. On her arms I emphasized strokes toward the body to help with lymph drainage and included Li 11, 10, 9 &4 to open up arms and give stagnant energy a place to go. She did not want abdominal work during the first few massages but during the last two sessions I did do some work through the sheet. On days when she had a head ache I was sure to include grasping down the GB meridian and lots of scalp massage, Li 4. Strokes on her legs were all towards the body to help with lymph drainage and I always gave a very nice foot massage to help soothe and relax. Points in her feet and legs included following Ki merdian from Ki 1, 2, 3 & 7 (8x). Lv 2-3 (50x). and St 36 (8x). On her back I used a little more pressure. Mostly long gliding strokes with focus on knots in levator scapulae and rhomboids. Sacral roll on low back and grasping. All shu points were included and stimulated 24x. On our last session I did reviving the yang to help with her low energy level (Ki1, Ki3, Sp6, St36, Cv12 Pc8, Li4, Gv15)

Over the course of the 9 weeks of treatment I saw some alleviation of tension in the neck, specifically the knot in L occipitals released. Tension also decreased in shoulders and rhomboids. When massages were weekly I noticed that her left leg was not as swollen most likely due to lymph drainage and increased circulation to that area. Her headaches were not as frequent and were always gone by the end of a massage. She really enjoyed all massages and felt very relaxed and rested. She and I plan on continuing to work together once our schedules settle into a regular routine. Now that I have learned the 64-point acupressure foot massage I would like to include that into the massage for her left foot/leg. Also, I would recommend a longer session with time at the beginning for a QiGong. She is open and interested in QiGong and I was hoping to start showing her the Dragon QiGong, which is good for weight loss and tonifying the meridians.

Arthritis Case Study

Nearly one in five Americans have arthritis or chronic joint symptoms. So not surprisingly there are two people in my household with some form of arthritis. With so many people having an issue with arthritis I chose it as my topic to research in pathology class so I would be more knowledgeable when I need to help a client with arthritis and so I could learn to better help the people close to me.

The person I chose for my case study has arthritis in her hands and ankles, a degenerative disk in her low back, and had recent surgery for a bowel obstruction. In the five elements of TCM arthritis would fall into the wood element, the low back pain would be influenced by the water element, and small intestine issues are part of the fire element.

For her six weeks of weekly massages I started out with the general one-hour relaxation pattern with some extra attention to her hands, ankles, and knees. I taught her the Small Intestines qigong for the dragon qigong we do in class to help with her digestion, but also because the movement rotates the wrist and arm up to the shoulder blade where she holds a lot of her tension. After two weeks with that qigong I showed her the Painting the World qigong to give some range of motion movements to her low back and also to massage the abdomen. I showed her yin-yang palms to get her wrists moving and the blood flowing. I told her how to massage her own abdomen with oil in a clockwise motion to help her heal from the surgery and to get her bowels moving.

Depending on what concerns she had the day of the massage I used some different acupressure points. Large Intestine 20 for her sinus headache along with the Large Intestines pain path down the arms for headaches. I used Stomach 8 to help calm her mind on a day she was noticeably stressed out, and spent some extra time on Stomach 41 for anxiety which I always use in a massage.

After six weeks of weekly massage she told me that she was pain free in her hands for 10 hours after the massage and pain free for 8 hours in her back. She really enjoyed the qigong movements. there was less inflammation in her back, the muscles around that vertebrae were less tense, with less chronic pain overall. she also commented that she felt a huge difference the next day in whether she drank a lot of water or not. Not drinking enough water left her feeling more achy the next morning.

If I was to continue working with this client I would make sure to keep up with the qigong movements, adding more when she felt like she had the ones I taught her memorized. I would make sure to spend extra time round rubbing her joints and low back. Now I know how good it feels to have a lot of time spent on round rubbing, especially rubbing clockwise on the low back, I would make sure to include it in her massage. I would get some Po Sum On oil to use when massaging her hands, Po Sum On oil is warming, helps to relieve pain and aids in circulation.

She loved getting massaged and was a great person to work with. Even with out the changes in her chronic pain she was very happy just to be relaxed after her long hours at work.