Build a Referal Network for your Massage Business

One of the most important things you can do for your massage business is learn how to build a referral network to keep your massage business going strong.  This is about creating relationships with others who will complement your business.   There are many types of referrals.  Start with your current clients by just asking them to send their friends and family your way. Most are happy to help.  Explain that you are building your business.  You don’t need to offer them incentives other than your great massage.

Then getting referrals from doctors and other health professionals can be a good source of new clients.

The first thing to think about is who do you want to get referrals from?  What type of work are you doing?  What kinds of clients do you want to work with?  Special diseases and conditions?  Athletes?  Car Accidents?  What solution do you provide?   Different doctors will be sources of different kinds of clients.

Chiropractors tend to get a fair amount of personal injury cases or car accidents although some people will go to their primary care doctor to start with.  Many doctors do not understand the role that massage has in healing inflammation and may advise against massage.  Finding people who do support massage will be the goal rather than trying to educate doctors who don’t already refer to massage therapists.  You can do that later when you have more time because it will take longer to educate doctors of this nature.

Create a list of potential health care providers.  Check out their credentials and talk to them first about what they do, what kinds of things that they work with and what their results are.  Go to these doctors yourself and experience their work.  Would you go there yourself or send your mother or partner there?  Would you send your kids there for treatment?  Early in my career I went to a chiropractor for my own health reasons and he hooked me up with an attorney and they both ended up being frequent sources of referrals.

Create a campaign to contact these providers.  You will have to test what works best.  You can try contacting them by letter or email.  You can directly ask for referrals and explain what you are doing or you can approach them more from an aspect of learning about their work.  This can make them more receptive to sending you referrals.  Send them some clients first to show them you respect them.   Don’t expect referrals back but do it from a place of just being able to provide the client with the best care.

You can also start by just contacting a health care provider who may have already sent you a client.  Send a 4-6 week simple progress report to show them what your massage is doing.   Most will actually like to know.   Once they start seeing the results you have a better chance of getting more referrals.

Call the provider when you have questions about caring for a client.  Do they have a new disease or condition that you need to know more information about?   Some will also just refer to you and say something like ‘ evaluate and treat’  which is giving you free reign.  You can send a report to show your findings from your assessment.   And yes massage therapist can not diagnose but they can surely report findings such as loss of range of motion and postural analysis.

What other ideas do you have for building a referral network of providers for your massage business?

Muscles of the Shoulder and Arm – Chart

Shoulder and arm
 Muscle Origin Insertion Action Notes
Deltoid Lateral one-third of clavicle, acromion and spine of scapula Deltoid tuberosity of humerus Abduct the shoulder jointPosterior fibers extend and laterally rotate shoulder. Anterior fibers flex and medially rotate the shoulder. Origin is identical to the insertion of the trapezius.
Supraspinatus”Rotator cuff” Supraspinatus fossa of scapula Greater tubercle of humerus – superior facet Abducts the humerus; stabilizes head of humerus in glenoid cavity.Medially rotates humerus, draws it forward and down when arm is raised. Deep to trapezius-runs underneath the acromion.(only rotator cuff muscle that doesn’t rotate)
Infraspinatus”Rotator cuff” Infraspinous fossa of scapula Greater tubercle of humerus – middle facet Laterally rotate, adducts, extends the shoulder. Stabilizes head of humerus in glenoid cavity Attaches just posterior to the supraspinatus on the greater tubercle.Works with teres minor.
Teres Minor” Rotator cuff” Superior half of lateral border of scapula Greater tubercle of humerus, lowest facet Laterally rotates, adducts, extends the shoulder, stabilizes head of humerus in glenoid cavity
Subscapularis”Rotator Cuff” Subscapular fossa of the scapula Lesser tubercle of the humerus Medially rotates shoulder joint, stabilizes head of humerus in glenoid cavity. Most often the culprit in “frozen shoulder”
Teres Major Inferior angle of scapula Medial lip of bicipital grove of humerus Adducts and medially rotates humerus and draws it back.
Serratus Anterior Outer surface of ribs 1-8 Anterior medial border of scapula Abducts and upwardly rotates scapula, holds scapula against thoracic wall Lower fibers interdigitate with the external obliques. Weakness causes winged scapula. Tightness may cause “a stitch in the side”
Coracobracialis Corocoid process of scapula Middle of medial shaft of humerus Flexes and adducts the humerus
Biceps Brachii Short head- Coracoid process of scapulaLong head- Supraglenoid tubercle of scapula Tuberosity of the radius and aponeurosis of biceps brachii Flexes elbow, supinates forearm, flexes shoulder joint
Triceps Brachii Long head- Infraglenoid tubercle of scapulaLateral head- Posterior surface of proximal half of humerus

Medial head- Posterior surface of distal half of humerus

All heads- olecranon process of ulna Long head- Extends and adducts the shoulderAll heads- Extend the forearm (elbow)
Subclavius First rib and cartilage Inferior, lateral aspect of clavicle Elevates first rib, stabilizes sternoclavicular joint, draws clavicle down Underneath the clavicle.
Brachialis Distal half of the anterior surface of humerus Tuberosity and coronoid process of ulna Flexes the elbow
Bracioradialis Lateral supracondylar ridge of humerus Styloid process of radius Flexes forearm (handshake position)
Pronator teres Medial epicondyle of humerus, coronoid process of ulna Middle of lateral surface of radius Pronates the forearmAssists in flexion of the elbow Resisted pronation
Forearm and hand
Extensor digitorum Common extensor tendon from lateral epicondyle of humerus Dorsal surface of middle and distal phalanges 2-5 ( four fingers) Extends four fingers, assists in extension of the wrist
Pronator quadratus
Palmaris longus Medial epicondyle of humerus Palmar aponeurosis Flexion of hand and wrist Flex wrist against resistance to find tendon.May be absent in one or both sides in some people.
Flexor digitorum superficialis Medial epicondyle of humerus, coronoid process of ulna, proximal radius Four tendons into the middle phalanges of fingers 2-5, palmar surface Flexes the middle and proximal phalanges of fingers 2-5, flexion of the wrist and forearm. Median nerve and ulnar artery are under origin
Flexor carpi radialis Medial epicondyle of humerus Base of 2nd to base of 3rd metacarpal bone Flexes and abducts the wrist, pronation of the forearm and flexion of the elbow
Flexor carpi ulnaris Medial epicondyle of humerus, medial olecranon and proximal posterior ulna Pisiform bone Flexes and adducts the wrist and flexes the elbow
Extensor carpi radialis longus Lateral supracondylar ridge of humerus Base of 2nd metacarpal bone dorsal side Extends and abducts the wrist, flexes the elbow
Extensor carpi radialis brevis Lateral epicondyle of humerus Dorsal surface of base of 3rd metacarpal bone Extends and assists in abduction of the wrist
Extensor carpi ulnaris Lateral epicondyle of humerus, posterior border of ulna Base of 5th metacarpal bone, ulnar side Extends and adducts the wrist Tendon runs through a groove between the head of the ulna and the styloid process of ulna
Flexor digitorum profundus Anterior and medial surfaces of proximal ¾ of ulna Four tendons into bases of distal phalanges on anterior surface Flexes distal interphalangeal joints of four fingers, flexes proximal interphalageal and metacarpopphalangeal joints
Flexor pollicus longus Anterior surface of radius, deep to flexors Distal phalange of thumb Flexes thumb
Supinator Lateral epicondyle of humerus, posterior ulna Proximal anterior shaft of humerus Supinates forearm
Extensor pollicus longus and brevis Posterior surface of radius and ulna, deep to extensors Brevis –proximal phalange of thumbLongus- distal phalange of thumb Extends the thumb
Opponens pollicis Palmar retinaculum, trapezium 1st metacarpal anterior surface Opposition of thumb to each digit.Rotates 1st metacarpal so the thumbnail faces the ceiling when the hand is resting palm up.

How long will it take to start your massage business?

If you are just looking into massage school or are in the midst of schooling, one of the most common concerns is how long will it take you to start and run your own massage business?   Many massage schools mistakenly will tell you that it will take many years – 4-5 at least.  Be sure to ask whoever is saying that it takes a long time to start a massage business what their experience is in running a business.

It really depends on what type of business you will be starting and many other things.

  • Do you have previous business experience- starting and running some other type of business?
  • Do you have previous experience in marketing or customer service?
  • Do you know how to build a SEO website that gets you most of your clients?
  • Do you have money saved in the bank to live on while you start so that you don’t have to work part time while trying to start a business?
  • Have you made your business plans?
  • Do you know how to negotiate rent for office space?
  • How many employees will you have or will it be just you? If it is just you, it is much easier really.
  • Have you or are you learning the skills of rebooking clients?
  • Have you or are you learning how to create a referral network from other businesses/people/health care providers?
  • Do you have set office hours and keep them even though you don’t have a client?

Just start where you are at.  You can easily start by renting a space from someone else to reduce your over head.

You will just need to be committed and persistent.  Go into the office everyday and work a full day at getting clients!  Most massage therapists seem to want more of their own time and will only go in when they have clients and don’t do the marketing that they need to be doing.  Be ready to see clients when they want a massage (within your office hours of course!)    Setting your hours provides a framework for doing business while also creating the ‘container’ for clients to feel safe and to trust you.

I asked on my Facebook Page – MassagePracticeBuilder

Laws of Physiology

Laws of Physiology

Studying the laws of physiology can give you a deeper understanding of what you are doing when you are working with clients. 

A law of physiology (as found in Taber’s medical dictionary) is a scientific principle that is uniformly true for a

whole class of natural physiological occurrences.  

Law of Facilitation
When an impulse has passed through a certain set of neurons to the exclusion of others, it will tend to take the same course on a future occasion and each time it traverses this path the resistance will be less.

Applications:
The nervous system conditions itself to find the path of least resistance. The body produces habitual patterns when a neural pathway is activated.  The law of facilitation answers the question, “why does it hurt in the same place every time?”
Old injuries tend to get re-aggravated with less stimulus.  Pain patterns tend to become set patterns in the body.  Once an area is injured or compromised you are more likely to have the injury occur again with less stimulation.  It will also take less time to heal itself again.
Also the more you get massage, the easier it is to relax.

Hiltons Law
A nerve trunk that supplies a joint also supplies the muscles of the joint and the skin over the attachments of such muscles. 

Applications:
If an injury occurs it may be difficult to determine if the pain is coming from the skin, muscle or joint. Stimulation of all areas in turn affects each part. Palpation and other tools are needed to assess the area.
This is one of the reasons why working superficially on the body will often create a deeper release of tissues.

Arndt-Schultz Law
Weak stimuli activate physiological processes: very strong stimuli inhibit physiological responses.

Applications:
Use gentler methods that are slower of less stimulating to activate physiological responses.  Doing deep tissue slowly and gently is more effective than using force.
Tissue that is gently agitated will heal faster than tissue that is left alone.  Weak stimulus activates tissue growth and wound healing.
Triggerpoints can give off strong impulses that can turn off other processes in the body. Whiplash injuries can influence the activity of the thyroid gland.
To turn off a response, use stronger stimuli.  To stop pain use cross fiber friction applied for a few minutes.

Davis’ Law
If muscle ends are brought closer together, then the pull of tonus is increased, thereby shortening the muscle which may even cause hypertrophy.  If muscle ends are separated beyond normal, then tonus is lessened or lost, thereby weakening the muscle.  If soft tissue is placed under unremitting tension, the tissue will elongate by  adding more material.

Applications:
If you don’t use it you lose it!

This can be seen in muscle imbalances where one ser of hypertonic muscles have shortened and become hypertrophied while the antagonists have weakened in response to their being stretched beyond normal.  A person with rounded or forward rolled shoulders will have tight, hypertrophied pec. major and minor muscles while their rhomboids will be weak.

Reciprocal Inhibition
When the agonist is firing and the affected joint moves, the antagonist group will be inhibited.  This is the basis for coordinated movements of the musculo-skeletal system.

Application:
This can be used to treat cramps or hypertonic muscles.
This is the basis for PNF -Proprioceptive neuromuscular facilitation.

All or none
The weakest stimuli capable of initiating a response, triggers an impulse that is transmitted along the entire neuron or muscle fiber, producing maximum strength response in cardiac and skeletal muscles and nerves.

Application:
A little can go a long way to produce a response.

In muscle contraction, all fibers of the muscle must contract for optimal functioning.  When adhesions and scar tissue form in the muscle, it reduces the effectiveness of the muscle.

Law of specificity of nervous energy
Excitation of a receptor always gives rise to the same sensation regardless of the nature of the stimulus.

Application:
It doesn’t matter which method you use to activate a sensory receptor, it will respond in a specific manner.  Technique or modality are not as important as the simple process of activating the sensory receptor in some manner in order to achieve a response.

Weber’s law

The increase in stimulus necessary to produce the smallest perceptible increase in sensation bears a constant ratio to the strength of the stimulus already acting.

Application:
Just a little bit more will change the perception.  For an application of massage to alter or change a sensory perception, the intensity of the application must match and barely exceed the existing sensation.  To overcome a perception of cold you would need to apply a compress which is at minimum one degree warmer than the areas temperature to create a sensation of warmth.

Pfluegger’s Laws- general laws that explain the body’s transition from an acute pain syndrome to a chronic pain syndrome.  A trauma to one part of the body, if left untreated will progress into a chronic full body condition.

Law of Unilaterality
If mild irritation is applied to one or more sensory nerves, the movement will take place usually on one side only, on the side that has been irritated.
Application: The body responds to trauma initially at the site of the injury.  Light stimulation remains fairly localized.  If a client experiences mild irritation it will likely effect the localized area on the side of the body in which the irritation has occurred.

Law of Symmetry:
If the stimulation is sufficiently increased, motor reaction is manifested not only by the irritated side, but also in similar muscles on the opposite side of the body.
Application:  If trauma is great enough, pain may be experienced on the opposite side of the actual injury.  By using increasing levels of massage intensity, a bilateral effect can be created even if massaging only one side of the body.  By massaging the unaffected side, the painful areas can be addressed without direct massage work.  This leads to the idea that applications of massage should take into account the whole body and that massaging the associated areas especially on the opposite side of the body will increase the overall affect of the massage.

Law of Intensity:
Reflex movements are more intense on the side of irritation and less strong on the opposite side.
Application: similar to the law of symmetry.  

Law of Radiation
If the excitation continues to increase, it is propagated upward and reactions take place through centrifugal nerves coming from the cord segments higher up.
Application:  Simulation will move up the spinal column and trigger reactions in the corresponding body areas innervated by those nerve segments. There may be spasming and pain above the actual site of the injury to protect the injured area.  (Muscle guarding)

Law of Generalization:
When the irritation becomes very intense, it is propagated in the medulla oblongata, which becomes a focus from which stimuli radiate to all parts of the cord, causing a general contraction of all muscles of the body.
Application: Very intense massage application can trigger whole body muscular contractions (massive muscle guarding). This is what trauma does to the body creating intense, generalized whole body muscular contraction.

Law of conservation of energy
Energy is constant: it is neither created or destroyed but only transformed from one form or another.
Applications:  The energy that is a result of a massage has been transformed or released within your client.
When a traumatic event such as a motor vehicle accident occurs, the energy of the force of the car is absorbed by the body.  Healing is achieved by releasing this energy from the body.

Murphy’s law
If something can go wrong it will.
Application : Never assume that something will never happen to you.  This is especially true when looking at issues that arise in the therapeutic relationship.  Be careful of dual relationships, power differences and boundaries.

Physiology of Inflammation

Stages of Inflammation:

Acute and chronic are terms commonly used to refer to the duration or the length of the problem, giving inaccurate information about the actual stage of inflammation. 

 For clarity of treatment, we need to define healing by the stage of inflammation and the symptoms, not the duration of the problem.

The three stages of inflammation:

  1. Acute -swelling stage

  2. Subacute – regenerative stage

  3. Chronic – scar tissue maturation and remodeling stage

Acute Inflammation is the swelling stage.  During this stage there is inflammation, redness and swelling due to the vascular changes.  There is exudation of cells and chemicals that cause the swelling and the pain.  If there is bleeding, hematomas form in this stage.  Secondarily, the chemical irritants are neutralized, the area is sealed off from surrounding tissue and circulation is impaired.  there is early fibroblastic cell activity. Symptoms are pain at rest and aggravated by activity.  the pain is felt over a diffuse area.  Secondary muscle spasm and guarding restrict passive movement.  In ROM, pain is felt before the tissue resistance is felt.  With injury to very deep structures or poorly vascularized areas, surface swelling and edema may not be noticeable. 

The subacute stage is the time of healing and repair.  Noxious chemicals are further neutralized. New capillary beds growing into the damaged areas are supported by connective tissue growth (collagen fibers) and together form granulation buds.  This new tissue is fragile and must be handled gently as it is easily injured.  Visible signs of inflammation subside.  ROM increases with pain felt at the point of tissue resistance.

The Chronic Inflammatory stage is the remodeling stage.  Signs of inflammation are absent and scar tissue is maturing. Pain is felt in the ROM after the tissue resistance at the end feel.  Maturation refers to the growth of the fibroblasts to fibrocytes and remodeling refers to the organization of and shrinking of collagen fibers along lines of stress.

In order to determine if the condition of the injury is in the acute, subacute or chronic inflammatory stage an adequate case history is needed along with assessment.  The history should include all incidence leading to the condition, past injuries and activities and a description of the symptoms being experienced.  The assessment should include a visual scan, active muscle testing, passive range of motion testing and resisted isometric muscle tests and palpation of the structure involved.

Treatment in acute stages includes intervention for the inflammation: ice, compression, elevation, relaxation and drainage.  Sports massage techniques use only gentle applications with no direct application of compression to the site of swelling.  Lymphatic drainage and relaxation of the muscle spasm are the acute treatment focus.  Avoid massaging the site of acute inflammation for the first 24 hours (unless you have been trained in this).  Activities should be limited to avoid unnecessary work of an injured part.  Too much use can re-injure the tissue.  However, a normal level of function and movement needs to be maintained to encourage proper tissue modeling and repair. 

A prolonged chronic stage or persistent disorder is not healing properly.  This may be caused by abnormal modeling of tissue during resolution of an acute disorder or injury.  Without resolution, abnormal amounts of collagen are produced, forming crosslinks that adhere to adjoining structures.  This limits the extensibility of the structure as well as prevents the formation of a smooth gliding surface between adjoining structures.  Proper amounts of mobilization are required for normal healing and prevention of adhesions.

Immature scar tissue is susceptible to re-tearing during repeated use.  Mobilization too early in the rehabilitation program can interfere with healing if the tissue is re-injured before it is properly healed.  Lack of adequate mobilization can result in adhesions that tear the injured tissue once movement is introduced.  The goals of treatment have not been met, inflammation has not been resolved and exercise to maintain normal use has not been incorporated.

Comparison of Stages of Inflammation

Stages of Inflammation Time Frame Symptoms ROM & Pain
Acute – beginning of healing stage From the moment of injury up to 3-4 days post injury Redness, Swelling (edema), heat, pain and often loss of function.  Muscle spasm and guarding.  Bruising if present, is black, blue, red or purple Pain is secondary to muscle spasm and guarding
Early Subacute – Granulation tissue and epithelialization stage. Within two days to two weeks Affected area shows diminishing signs of inflammation, pink, warm, slightly edematous, somewhat less painful tissue.  Muscle spasm diminishes.  Bruising if present, relatively unchanged With ROM pain is experienced when tissue resistance is encountered.
Late Subacute – wound retraction and scar remodeling stage Begins 2nd to 3rd week of subacute stage May or may not be a pocket of residual swelling.  Minimal discomfort but potential loss or ROM due to adhesions and muscle weakness.  If bruising present it changes to yellow, brown, green and then disappears. Pain is encountered with overpressure (stretch) to the affected tissue
Chronic- restoration of function Overlaps with the latter part of the subacute stage at about 2-3 weeks post injury up to 1-2 years Inflammatory process is resolved.  No edema, but there is loss of full ROM Pain is encountered with overpressure (stretch) to the affected tissue or secondary stress placed on the contracture

How Muscles Work – Contraction

Muscle Contraction – Skeletal Muscles

Sliding Filament Theory

  1. Motor Neuron sends nerve impulse to the muscle cell.  They can carry messages to contract or inhibit contraction.
    Nerve impulse signals the release of acetylcholine (neurotransmitter) from the synaptic vesicles into the synaptic vessel
  2. Acetylcholine moves across the synaptic cleft and starts the action potential that moves from the end plate to the sarcolemma
  3. The Acton Potential enters T tubules and sarcoplasmic reticulum releasing calcium into the sarcoplasm
  4. Calcium uncovers binding sites on the actin
  5. Receptor sites on actin attach to the myosin cross bridges
  6. Energy from ATP breakdown cause the myosin cross brides to swivel causing the actin to slide past the myosin
  7. Zdiscs are pulled together and the muscle shortens.
  8. Acetycholinesterase breaks down acetylcholine
  9. Calcium is pumped back into the sarcoplasmic reticulum.  Low levels of calcium stop the myosin from moving.
  10. The sarcomere returns to its resting length.

 Sarcomere

All or None Principle

Muscle fibers of motor units will contract to their fullest extent when they are stimulated to the threshold.

Motor neuron sends stimulus and all muscle fibers respond to contract at the same time.  Applies to motor units only, not the whole muscle.

Muscular System

Muscular System

Types of Muscle Tissue:

  1. Skeletal – moves bones, contract by will.  Striated or striped in appearance- voluntary

  2. Visceral – not consciously controlled, smooth muscle – involuntary

  3. Cardiac- involuntary unique to the heart, ability to contract continuously

Naming Skeletal Muscles

Master Muscle List for Massage Therapists

Anatomy of Muscles

  1. Bundles of Fibers

  2. Nerve and Blood Supply

  3. Muscle Attachments – Tendon – attaches muscle to bone.  Aponeurosis – broad attachment attaches muscles to bones or other muscles. Fascia – broad sheets of connective tissue that holds muscles together

Physiology

   Properties:

  1.  Contractility – the ability of tissue to shorten and thicken; also the ability of the tissue to do the work

  2. Extensibility – the ability of the tissue to be stretched

  3. Elasticity – the ability of the tissue to return to its original shape after being shortened or stretched

  4. Irritability –  excitability capacity to respond to stimulus

  5. Excitability/Conductivity – ability of tissue to receive and respond to stimuli; spreads transmission over surface in response to nerve impluse which allows whole unit to contract

Function of Muscle Tissue:

  1. Form the shape of the body.  In neutral or contracted state, the muscles form our exterior shape

  2. Generate Heat – As muscles contract, they generate heat

  3. Initiate movement

  4. maintain posture – imbalances in the posture occur when there is unbalanced muscle contraction

Muscle Contraction:

  1.  Stimulus – anything that causes a muscle to contract

  2. All or None principle

  3. Fatigue – lactic acid, oxygen debt

  4. Muscle tone – muscles ability to stay partially contracted

Function:

  1.    Movement – origin – less movable; fixed attachment. Insertion – attachment to part of the body that muscle pulls into action.

  2. Prime Mover- main muscle that accomplishes movement
    Synergist – helpers to prime movers
    Antagonist – produce opposing movement
    Fixator – Fix a point of body so other muscles can move agains Point.

  3. Terminology

  4. Joint Movements

  5. Exercise

Disorders of Muscles

  1.  Strain – detachment of muscle from bone or tearing
    Sprain – ligament injuries, blood vessels and nerves involved
    Cramps

  2. Atrophy – wasting or decrease of muscle

  3. Myalgia – muscle pain
    Myosytis – inflammation of muscle tissue – loss of function
    Fibrositis -inflammation of connective tissues of muscles and joints
    Bursitis – inflammation of fluid filled sac that minimizes friction between tissues and bone

  4. Muscular Dystrophy

  5. Myesthena Gravis – fatigue of muscles

  6. Fibromyalgia

Kinesiology Test Questions

Kinesiology Test Questions for Massage Students

The correct answers are the listed at the end of the question.

1.      The iliopsoas hikes up the hip because of its insertion on the   a) femur  b) greater trochanter   c) lesser trochanter

d)  ischial tuberosity     C

2.      Which structure supports the body in the sitting position   a)sacrum  b) coccyx  c) ischial tuberosity   d)  hamstring     C

3.      Which statement is true about Golgi tendon apparatus?  a)  they are found in joint capsules   b)  they detect the overall tension of the tendon  c) there are a higher number of them in gymnasts   d)  they insert on the greater tuberosity   B

4.      Which muscle latterally rotates, medially rotates, extends and flexes?   A) gluteus maximus  b) gluteus minimus  c) gluteus medius   d) quadratus lumborum    C

5.      Which muscle adducts and medially rotates the femur at the hip?  a) gluteus medius  b)pectineus  c)quadratus femoris  d) tensor fascia lata    B

6.      Which muscle is closet to the sciatic nerve?  a) gracilis  b) piriformis c) gluteus medius  d) pectineus    B

7.      Which muscle laterally rotates the femur at the hip joint?  a)  Pectineus  b) gluteus minimis  c) sartorius  d)  all of the above    B

8.      A muscle contraction in which the distance between ends of the muscle changes is called  a) isotonic  b) resistant  c) distal  d) isometric   A

9.      Which of the following does not flex the wrist?  A) flexor carpi radialis b) flexor carpi ulnaris c) pronator quadratus d) palmaris longus  C

10.  What forms the outer layer of the anterior and lateral abdominal wall?  A) rectus abdominis  b) transversalis  c) serratus anterior  d) external oblique   D

11.  The primary flexor of the distal phalanx of the fingers is a)flexor carpi ulnaris b) pollices longus  c) flexor digitorum profundus  d) flexor carpi radialis  C

12.  Which muscle elevates and depresses the scapula?  A) trapezius  b) latissimus dorsi c) rhomboids  d) all of the above    A

13.  With the elbow flesed, which muscle supinates the hand?   a) pronator b) supinator c) quadratof d) brachialis  B

14.   Which of the following moves and extremity away from the midline?  a) adductor  b) abductor  c)flexor  d) rotator   B

15.  What is the band of strong, fibrous tissue that connects the articular ends of bones together?  a) membrane b)fascia c) tendon  d) ligament    D

16.  At the wrist, the radius articulates with the a) lunate and scaphoid b) lunate and zyphoid  c) trapezoid and hamate d) capitate and hamate  A

17.  The popliteus muscle of the leg a) abducts b) extends c) plantar flexes the ankle d) medially rotates the tibia   D

18.  Which muscle is innervated by the axillary nerve?  a) deltoid  b)bracialis  c) pectoralis major  d) all of the above   A

19.  What do the following muscles have in common:  SCM, biceps brachii, hamstring?  a)flexors b) adductors c) extensors d) abductors    A

20.  Which muscle abducts the scapula?  a) serratus anterior/pectoralis minor  b)rhomboids c)latissimus dorsi  d) trapezius      A

21.  What muscle plantarflexes and everts the foot?  a) tibialis anterior b) gastrocnemius c)plantaris  d)peroneus longus     D

22.  Which muscle is not part of the rotator cuff?  a) supraspinatus  b) infraspinatus  c) teres major  d) teres minor   C

23.   The largest and strongest tarsal bone is the a) calcaneus b) cuboid c) lateral cuneiform  d) navicular   A

24.  Which of the following joint classifications is described as freely movable?  a) ampiarthrosis b) cartilaginous c) diarthrosis  d) fibrous  C

25.  The joint between the trapezium carpal bone and the thumb’s metacarpal is which kind of joint? a) ball and socket  b) ellipsoidal c) gliding  d) saddle  D

26.  Which facial muscle is the major cheek muscle?  a) buccinator b) depressor labii inferioris c) mentalis d) platysma  A

27.  Which of the following is not a part of the erector spinae group?  A) iliocostalis b) longissimus c)spinalis d) sternocleidomastoid  D

28.  Which muscle is responsible for supination of the forearm?   a) coracobrachialis b) triceps brachii c) biceps brachii d) brachioradialis  C

29.  The insertion of the sternocleidomastoid is the   a) sternum  b) hyoid  c) clavicle  d) mastoid process      D

30.  What is the action of the teres minor :  a) medial rotation of humerus b)lateral rotation of humerus c) flexion of humerus  d) flexion of forearm  B

31.  What are two adductors of the scapula?  a) rhomboids/traps  b) rhomboids/serratus anterior  c) rhomboids/levator scapula   d) all of the above   A

32.  The trapezius is an antagonist to itself in which actions: a) elevation   b)  depression  c) adduction   d)  a and b       D

33.  The knee joint is a    a) gliding   b) pivot  c) modified hinge  d) none of these    D

34.  The serratus anterior is an antagonist to the rhomboids in a) adduction  b) downward rotation  c)depression  d) elevation    A

35.  Which of the rotator cuff muscles does not participate in rotation?   a) infraspinatus  b) supra spinatus  c) teres minor  d) subscapularis   B

36.  C1- Occiput is what type of joint?  a) gliding  b) pivot c)ellipsoid  d) hinge   C

37.  The latissimus dorsi, deltoid and triceps all have a common action which is  a) flexion  b)abduction c) adduction  d) extension      D

38.  The long head of the biceps bracii originates on  a)lessser tubercle of the humerus  b) infraglenoid tubercle  c) supraglenoid tubercle  d) lesser trochanter   C

39.  Because of its insertion on the ulna, the true flexor of the elbow is the  a) corocobrachialis  b) biceps brachii c) brachialis  d) bracioradialis   C

40.  Which muscle originates posterior to ASIS?  a)  adductor longus  b) pectineus  c) gracillus  d)  Tensor fascia late    D

41.  Extensors of the hand and wrist have a common tendon origin on  a) lateral epicondyle of the humerus  b) medial epicondyle of humerus  c) supracondylar ridge of humerus d)  palmar aponeurosis    A

42.  In order for the forearm to pronate, the pronator teres must insert on which bone?  a) ulna  b) radius  c) humerus  d) styloid process of radius   B

43.  The piriformis inserts on the  a) anterior sacrum  b)  lesser trochanter  c) greater trochanter  d)  gluteal tuberosity    C

Muscles of the Hip – Chart

Muscles of the Hip Chart for Massage Therapists

Pelvis  Origin Insertion  Action  Notes 
Gluteus maximus Posterior ilium, sacrum coccyx Femur (greater trochanter) and Iliotibial band Forceful extension of the hip, lateral rotation of extended hip, abduct hip (IT band), lower fibers (inserting on trochanter) adduct hip,
External rotation
stabilizes knee

 

Gluteus medius Ilium between posterior and anterior gluteal lines (below crest) Greater trochanter of femur Abducts and rotates thigh medially (internally), abducts, flexes and extends the hip stabilizes pelvis 
Gluteus minimus Posterior ilium between anterior and inferior gluteal lines Anterior surface of greater trochanter of femur Abducts and medially (internally) rotates thigh, stabilizes pelvis on femur stabilizes pelvis 
Tensor fascia latae Anterior iliac crest (posterior to anterior superior iliac spine) Iliotibial band which continues to attach to lateral condyle of tibia Flexes, internally:
rotates and abducts thigh,
prevents collapse of extended knee in walking
Psoas major Lumbar vertebrae, T12-L5
Bodies and transverse processes 
Lesser trochanter of femur Flexion of hipWhen femur is stabilized it may increases the lordotic curve in the lumbar spine and rotates the pelvis downward.

Alternate theory: acting with posterior transversospinalis act to erect (lift or straighten) the spine

Provides support for the spine and maintains disc space when functioning properly.

 

Iliacus Iliac fossa Lesser trochanter of the femur Flexes, laterally rotates and adducts the hipWith femur fixed, acts in rotating pelvis anteriorly
Piriformis Anterior surface of the sacrum Greater trochanter of femur External rotation of femurAdducts the thigh when the hip is flexed

With femur fixed, bilaterally moves pelvis backward (decreasing lordosis); unilaterally medially rotates pelvis

 Deep lateral rotators
(Superior and Inferior Gemelli, Obturator Internus and Externus, Quadratus femoris)
Ischium, obturator foramen  Trochanter  Laterally rotate thigh, stabilize hip 

Muscles of the Forearm and Hand – Chart

Muscles of the Forearm and Hand Chart for Massage Therapists

Forearm and hand        
 Muscle Origin  Insertion  Action  Notes 
Extensor digitorum Common extensor tendon from lateral epicondyle of humerus Dorsal surface of middle and distal phalanges 2-5 
( four fingers)
Extends four fingers, assists in extension of the wrist  
Pronator quadratus        
Palmaris longus Medial epicondyle of humerus Palmar aponeurosis Flexion of hand and wrist Flex wrist against resistance to find tendon.May be absent in one or both sides in some people.
Flexor digitorum superficialis Medial epicondyle of humerus, coronoid process of ulna, proximal radius Four tendons into the middle phalanges of fingers 2-5, palmar surface Flexes the middle and proximal phalanges of fingers 2-5, flexion of the wrist and forearm. Median nerve and ulnar artery are under origin
Flexor carpi radialis Medial epicondyle of humerus Base of 2nd to base of 3rd metacarpal bone Flexes and abducts the wrist, pronation of the forearm and flexion of the elbow  
Flexor carpi ulnaris Medial epicondyle of humerus, medial olecranon and proximal posterior ulna Pisiform bone  Flexes and adducts the wrist and flexes the elbow  
Extensor carpi radialis longus Lateral supracondylar ridge of humerus Base of 2nd metacarpal bone dorsal side Extends and abducts the wrist, flexes the elbow  
Extensor carpi radialis brevis Lateral epicondyle of humerus Dorsal surface of base of 3rd metacarpal bone Extends and assists in abduction of the wrist  
Extensor carpi ulnaris Lateral epicondyle of humerus, posterior border of ulna Base of 5th metacarpal bone, ulnar side Extends and adducts the wrist Tendon runs through a groove between the head of the ulna and the styloid process of ulna
Flexor digitorum profundus Anterior and medial surfaces of proximal ¾ of ulna Four tendons into bases of distal phalanges on anterior surface Flexes distal interphalangeal joints of four fingers, flexes proximal interphalageal and metacarpopphalangeal joints  
Flexor pollicus longus Anterior surface of radius, deep to flexors Distal phalange of thumb Flexes thumb  
Supinator Lateral epicondyle of humerus, posterior ulna Proximal anterior shaft of humerus Supinates forearm  
Extensor pollicus longus and brevis Posterior surface of radius and ulna, deep to extensors Brevis –proximal phalange of thumbLongus- distal phalange of thumb Extends the thumb  
Opponens pollicis Palmar retinaculum, trapezium 1st metacarpal anterior surface Opposition of thumb to each digit.Rotates 1st metacarpal so the thumbnail faces the ceiling when the hand is resting palm up.