Forward Head Posture. Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Forward Head Posture

The neck and head do not contribute to the generation of pressure, so head and neck posture should be whatever is most comfortable and least stressful. Forward head posture, a common postural distortion imbalance pattern that occurs is caused by a flexion of the head and neck.

Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Deep Strokes

To transition to perform deep strokes and maintain proper body mechanics, it is necessary to transition from being perpendicular to be slightly horizontal to glide along the client’s body. However, minimize the horizontal direction or pressure into the client’s tissues will be lost.

Back Postures. Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Use Body Weight

An excellent demonstration of the force that can be generated by using body weight is to lean down onto a bathroom weight scale that is placed on a table that is positioned as various heights. Simply relax and lean into the scale with your body weight and notice the force that you generate.

Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Support Your Treatment Contact

Bracing the contact means that the two hands must work together instead of each contacting the client separately. Less area of the client’s body will be covered this way, but stronger and more efficient pressure will be created at the area that is being worked, which is more important when deep pressure is needed.

Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Apply Pressure Perpendicularly

Maximal pressure for the effort used is achieved if the angle of your force into the client is perpendicular to the contour of the region being worked. To apply this concept of working perpendicularly, the client’s back and pelvis can be divided into separate regions based on the curve of each region.

Permission Joseph E. Muscolino. Advanced Treatment Techniques for the Manual Therapist: Neck (2013).

Neck Deep Pressure Massage: Step by Step – Engage the Tissues

Being able to feel tissue tension barrier is the one most crucial aspect for a clinical orthopedic manual therapist performing deep pressure massage. From a mechanical standpoint, it is only pressure beyond the tissue tension barrier that effects therapeutic change (this is not necessarily true neurally).

Permission Joseph E. Muscolino. Advanced Treatment Techniques for the Manual Therapist: Neck (2013).

Neck Deep Pressure Massage: Step by Step – Deep Stroking Massage

When performing deep pressure massage, deep stroking massage must originate from your core by further rocking your pelvis and extending your spine forward. Short deep strokes to the neck between 1 and 2 inches (2-5 centimeters) in length allow you to preserve optimal body mechanics.

Permission Joseph E. Muscolino. Advanced Treatment Techniques for the Manual Therapist: Neck (2015).

Neck Deep Pressure Massage: Step by Step – Contacts

Even perfect body mechanics cannot eliminate all physical stress to your body when doing massage. Ideal body mechanics merely minimize the stress. For this reason, when doing massage, especially deep pressure massage, it is wise to alternate which treatment hand contact you use during a session.

Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Tissue Tension Barrier

Being able to feel tissue tension barriers is the one most important hands-on skill that an orthopedic manual therapist needs. Clinical orthopedic manual therapy (massage and stretching) only effects change if we reach tissue tension and then apply slightly more force beyond it.

Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Choosing the Treatment Contact

When working the low back, a good strategy is to begin with a smaller treatment contact such as thumb or finger pads to assess and begin treatment of the lumbar region, and then switch to a larger contact such as the palm or elbow to deliver deeper pressure.

Permission Joseph E. Muscolino. Manual Therapy for the Low Back and Pelvis - A Clinical Orthopedic Approach (2013).

Deep Pressure Massage to the Low Back – Client and Therapist Positioning

A common body mechanics error is for the therapist to stand above the face cradle at the head end of the table. Standing here only distances you from the client, causing you to lean over the client to reach the low back; this compromises body mechanics and does not allow for the efficient use of body weight.

Permission Joseph E. Muscolino. www.learnmuscles.com

Deep Pressure Massage to the Low Back – Choosing the Right Table

Even more important than table width is table height. As a rule, when generating deep pressure, you want the table to be as low as possible so that you can more easily position your body above the client to take advantage of gravity and body weight.