Salvo: Massage Therapy Principles and Practice, 4th Edition
Answers to End-of-Chapter Test Your Knowledge activities
Matching and Critical Thinking Questions
Chapter 1
Matching
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Critical Thinking
Knowledge of massage therapy’s long documented history as an effective
healing art and its equally long association with rehabilitation medicine can
enhance a therapist’s self-respect and professionalism. Understanding how this
and other similar modalities have evolved, whether they developed from ancient
traditions or incorporate cutting-edge research (or both), could help a therapist
select a method/technique specialty or point him or her to resource materials that
can deepen their appreciation of their chose modality.
Matching II
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Chapter 2
Critical Thinking
Boundaries define the massage therapist's personal and
professional space, his or her emotional separateness, sense of
autonomy, how he or she conducts business affairs, and how he or
she establishes and maintains different kinds of relationships.
Boundaries impart a sense of self, personal space, and a sense of
protection for both the client and the therapist. Boundaries help to
clarify each person’s role in the therapeutic relationship such as
individual responsibilities, expectations, and limitations. Through
boundaries, the therapist creates a sense of safety and security and
a relationship that is predictable for clients. When therapists are
aware of their boundaries, they can maintain them easier. The
more awareness and respect they have for their own boundaries,
the more they can respect the boundaries of others. By doing so,
they instill a sense of dignity and respect to their clients, to the
profession, and to themselves.
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
Matching I
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Chapter 3
Critical Thinking
Although the skill and professional appearance of the massage
therapist are the most important aspects of a successful practice,
they are not the whole story. The atmosphere of the massage
studio helps to enhance the confidence of the client; stained linens
or inadequate storage room for personal items will make the client
feel uneasy and the therapist seem unprofessional. In addition, if
the client is physically uncomfortable (e.g., if the room is too cold
or noisy), he or she will find it more difficult to relax during the
session. The décor of the room influences the “feel” of the
massage being offered and can significantly enhance or detract
from the massage experience. For example, a massage room that
resembles a doctor’s office may be clean and professional, but
such an atmosphere would detract from a stress-reduction massage
for many clients.
Chapter 4
Critical Thinking
In order to give our best and to pass along our gifts to others, we
must take care of ourselves. When we have good health, fitness,
psychologic and emotional balance, and energy, we will be less
likely to become injured, emotionally depleted, or sick. When
massage therapists model for their clients the habits they are
recommending, they will be less likely to have problems with
boundaries or emotional entanglements, and they will take
themselves less seriously.
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
Matching I
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Matching II
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Chapter 5
Critical Thinking
If massage therapists really understand how massage therapy
works, then they are more likely to know they are using the best
methods and techniques to achieve optimal results their clients.
Insurance companies and clients are more likely to pay for a
therapy and physicians are more likely to prescribe massage
treatment when massage therapists can tell them exactly what the
treatments they are performing are doing to the client's body.
Research is simply a way to find how massage therapy works.
When massage therapists understand how research is done, can
locate research studies, understand parts of a typical research
paper, they can approach situations that involve research with a
new found confidence. Ultimately, they will be able to better
answer their clients’ questions. On a larger scale, they will be part
of a profession that gains credibility with every study conducted
into the efficacy of massage therapy.
Chapter 6
Critical Thinking
When an injury first occurs, inflammation and broken blood
vessels are common. The purpose of inflammation is to stabilize
the injured area, contain infection, and initiate the healing process
for damaged tissue. Cardinal signs of inflammation are heat,
redness, swelling, pain, and loss of function. Massage during this
acute phase would probably be very painful and could delay
healing. In addition, injuries should be evaluated for breaks or
other problems requiring medical treatment before massage is
performed. Once the acute phase is over and the client has
received any needed medical treatment, massage might be
indicated to increase circulation to the damaged area and help
promote healing. Initial suggested techniques are light gliding and
light friction strokes over the area, gradually increasing pressure
while staying within the client’s tolerance. Then, cross fiber
frictions are used to create more appropriate scar. Initially,
treatments of shorter duration are indicated and can become longer
as the area becomes more accustomed to pressure.
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
Matching I
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Chapter 7
Critical Thinking
There are several differences between being in bed and being on a
massage table that make bolster use important for massage. One is
that the client’s bed is softer than the massage table; even a wellpadded table is harder than most beds. Another is that, in bed, the
client can sleep in any position he or she chooses and turn at will
whereas, on the massage table, the client’s position is determined
primarily by the body part being massaged. Finally, the therapist
often applies pressure during massage, making it important to have
the body well supported from beneath; the relatively firm table and
other supportive devices serve this purpose. Also, muscles and
their related joints are more prone to relax when they are resting
against a cushion.
Chapter 8
Critical Thinking
The physiologic effects of massage strokes must be considered
when developing a treatment plan for each client. Generally,
massage is delivered using effleurage followed by deeper pressure
to affect deeper tissue layers next. This progression both warms
and prepares the tissue for deeper work as well as soothes and
relaxes the client. Effleurage is also used as a palpation tool to
assess tissues, giving the therapist more information about the
condition of the skin, fascia, muscle, and areas than need focused
attention. Effleurage is also used frequently as a transition stroke
for continuity. Pétrissage, friction, and vibration can all work the
muscle and connective tissue more vigorously and the order in
which they are used, and even whether to include them, should be
considered on a client by client basis. Tapotement is often
performed at the end to finish the treatment, or to finish and
invigorate an area, if the treatment plan indicates its use; clients
who want a soothing, stress-reducing massage should not receive
vigorously applied tapotement. Using a sequence also helps
prevent repetitive motion injury to the therapist.
Chapter 9
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
Matching I
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Matching I
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Matching II
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Critical Thinking
Students may describe the agents of disease and the various
modes of transmission, and note that contagious diseases
can be spread through massage. Because massage therapists
will encounter clients who have medical conditions, having
a basic knowledge of how diseases are transmitted will
allow therapists to take precautions to control infection and
reduce or prevent the spread of disease. It is also important
to know which diseases are not contagious.
Chapter 10
Critical Thinking
Clients give out nonverbal clues in the form of body language
throughout the treatment period. When the client arrives, during
consultation, assessment, and implementation, he or she is
responding to emotions, expectations, and physical sensations in
the form of posture, facial expressions, movements, and breathing
patterns. For example, a client may express discomfort by
grimacing or holding the breath. A client may express nervousness
or anxiety with shallow breathing, quick, uncoordinated
movements, or unfocused attention. Posture and movement give
important clues about physical dysfunction or pain. The massage
therapist should be watching for nonverbal clues during the
interview process. These clues give the therapist a chance to ask
further questions about the client’s health and well-being to be
able to formulate the best treatment plan for the client.
Chapter 11
Critical Thinking
The main things to remember when dealing with a client
with special needs are to treat the client with dignity and
respect and to communicate directly with the client as much
as possible. Do not assume that a client cannot give answers
or make decisions unless you know this for certain (e.g., in
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
6. K
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Matching I
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Matching II
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the case of a very young client or one with a known mental
disability; even in these situations, direct as much of the
information and questioning as possible to the client rather
than to the caregiver). Respectful questioning and careful
listening are especially critical in the case of a client with an
unfamiliar condition or special need; conversely, the client
is likely to appreciate the attention and care given to his or
her unique situation. Be sure to research any condition for
which you are unfamiliar from a authoritative reliable
source.
Chapter 12
Critical Thinking
These treatments enhance the effects of massage by aiding
relaxation, healing, and general well-being. They are used in many
practices where massage is used, such as day spas. Many massage
clients value these treatments and can benefit from them.
Chapter 13
Critical Thinking
The massage therapist learns by doing, but also by receiving
massage and reflexology techniques. The therapist is able to
determine what feels good to his or her own body and is
able to then apply those techniques to a client. Receiving
foot reflexology might teach the therapist new techniques
that he or she has never tried before and could add more to
treatment planning with the inclusion of these additional
techniques.
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
10. B
11. A
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Matching I
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Matching I
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Matching II
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Chapter 14
Critical Thinking
Ideal body alignment, posture,and gait allow all the parts of the
body to function harmoniously. Alterations in structure and
muscular imbalances (i.e., spinal curvature, forward head posture,
muscle weakness, etc.) interfere with the proper functioning of the
body due to overcompensation, pain guarding, and compression or
distortion of organs, nerves, and the circulatory system.
Abnormalities may be acute or chronic; the longer the
abnormalities exist, the more soft-tissue compensation is involved.
Chapter 15
Critical Thinking
Some people do not like to be touched and might feel
threatened by what is expected of them in a massage done
on a table. They do not want to go into a private room and
remove their clothing for a stranger. Their feeling of
vulnerability is greatly reduced with a seated massage,
where they remain clothed and are often in a room with
other people. Seated massage may help change those who
are uncomfortable with the thought of receiving massage by
providing structured, therapeutic touch.
Chapter 16
Critical Thinking
Students might discuss any of the following ideas: How does the
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
2. I
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style of medicine affects the quality of life? How much time does
the average person spend in pain or illness? What is the life
expectancy of a person? Are there conditions that one style treats
more effectively than the other? What long-term effect does each
style have on the health of the society in which it has evolved? It is
likely that students will recognize that practitioners of one style
can learn from those of the other.
Chapter 17
Critical Thinking
Understanding business practices will help massage therapists
decide whether to work for someone else or set up a personal
business. Going into business is a complicated matter: tax and
other laws must be followed; the business must be promoted to be
known to potential clients; and a business that is operated in an
efficient manner will be more rewarding, both personally and
financially, than one that is approached without a solid foundation
of business knowledge.
Matching II
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Chapter 18
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Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
9. K
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Critical Thinking
Knowledge of the tissues that the massage therapist is kneading, pulling, stretching, or
chucking will give the therapist a clearer mental picture and understanding of what is
beneath his or her hands. Knowing the proper terms for all of the components of the body
and how they work will help the massage therapist communicate effectively with the
client and allied health care providers about areas of the body and about how modification
of one body system could affect another.
Matching I
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Chapter 19
Critical Thinking
Medications used for pain as well as inflammation
include nonsteroidal antiinflammatory drugs (NSAIDs),
corticosteroids, muscle relaxants, and narcotics. The most
common side effect of NSAIDs is gastrointestinal distress
(cramping, heartburn, nausea, diarrhea, constipation). This
may also occur with other meds. Be sure to avoid the
abdomen in these cases.
Some people report that they bruised easily; others
reported feeling drowsy or dizzy. If your client bruises
easily, use caution with deep pressure and aggressive
techniques. If your client is feeling drowsy or dizzy,
consider end session with stimulating strokes and instruct
client to move slowly and carefully; be ready to assist the
client in sitting or standing up while maintaining proper
draping after the massage.
Reduced sensation, which is a therapeutic effect and not a
side effect, is factored into the treatment plan. Again, use
caution when applying deep pressure and aggressive
techniques as the client may be unable to detect pressure
that is causing injury. Long-term use of corticosteroids
reduces the density, strength, and resiliency of connective
tissues, resulting in thinning skin, osteoporosis (especially
postmenopausal women), and loss of muscle mass.
Prolonged corticosteroid use results in slow healing time,
poor tissue quality after healing, and generalized poor
immune response. Because of this, caution with deep
pressure and aggressive techniques because of reduced
tissue integrity. There are no massage considerations for
short-term use (30 days for less) of corticosteroids.
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
9
Answers to End-of-Chapter Test Your Knowledge activities
10
Acetaminophen, which may also be used by your
client, does not produce any side effects that would affect
massage
Matching I
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Matching I
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Chapter 20
Critical Thinking
A massage therapist will encounter clients who are suffering from
a wide variety of muscular pathologies, and the type and severity
of the muscle condition can dictate how the massage therapy
session will be conducted. During the intake, a massage therapist
can ask questions that will help him or her better understand the
client’s lifestyle, present health, and medical history. For example,
a client might reveal that he or she has been diagnosed with
muscular dystrophy. Because some clients might be embarrassed
to discuss their eating or exercise habits, the massage therapist
might not discover flaccid or atrophied muscles until the client is
on the table. In such cases, the therapist might discuss the client’s
condition after the massage, if appropriate, by suggesting
therapeutic movements as a way to prolong the effects of massage.
In other cases, such as an elderly client who might have
undiagnosed Alzheimer’s disease, the massage therapist might
suggest that a client visit his or her physician. As always, the
massage professional should refrain from making a diagnosis.
Matching II
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Chapter 21
Matching III
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Matching IV
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5. A
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Matching V
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8. L
9. F
10. I
11. J
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
12. F
Matching VI
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Matching VIII
Matching IX
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Matching XIII
Matching XIV
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Chapter 21 cont'd
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Critical Thinking
“Rotator cuff” is the common name for the musculotendinous cuff, a group of four shoulder
muscles that help stabilize the glenohumeral (shoulder) joint and that can act as ligaments. These
muscles permit the joint to have a wider range of motion than any other joint. Tears can occur in
the tendons. Frequent use of the hands and arms in the overhead position can weaken and injure
this area; for example, painters and baseball pitchers are susceptible to rotator cuff injury. In
addition, any activity involving intense use of the shoulders can weaken the rotator cuff over
time. Falls (especially onto an outstretched hand) and other trauma to the shoulder can also cause
rotator cuff tears.
Chapter 22
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
Matching I
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12
Critical Thinking
The type and severity of various skin conditions dictates how the
massage therapy session will be conducted. For example, sensitive
skin may require a more gentle touch, and dry skin may require
more moisturizing lubrication. Skin color is often an indicator of
the health of the individual and of the skin. Redness may indicate
injury or pathology and may be seen in people with inflammation,
fever, or allergies. Excessive blood flow, such as seen during
exercise, blushing, or hot flashes can also be a cause. Ischemia or
hypoxemia can give skin the blue or purple cast of cyanosis. Pallor
is often seen in persons with anemia. Individuals with jaundice or
liver disorders may have a yellow-gold color to their skin and eyes
from increased levels of bilirubin.
Additionally, the presence of certain conditions such as athlete's
foot and severe pustular acne are local contraindications for
massage. The communication between massage therapist and
client is not a monologue, it is a dialogue. Both spoken
communication and touch help guide the massage therapist to
create therapeutic impact. The massage session should ultimately
be client focused and experience and education led.
Chapter 23
Matching
Critical Thinking
III
1. C
Paralysis on one side of the body indicates a
2. K
possible stroke. Because each brain
3. G
hemisphere is linked to the opposite side of
4. D
the body, her condition could be caused by a
5. A
stroke on the right side of the brain. Paralysis
6. E
due to a spinal cord injury is likely to affect
7. J
both sides of the body, resulting in paraplegia
8. L
or quadriplegia.
9. I
10. F
11. B
12. H
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
Matching I
1. F
2. L
3. G
4. D
5. E
6. J
7. C
8. I
9. K
10. A
11. H
12. B
Matching I
1. B
2. I
3. D
4. E
5. K
6. A
7. J
8. G
9. L
10. C
11. F
12. H
Matching II
1. F
2. K
3. L
4. I
5. D
6. B
7. H
8. G
9. E
10. A
11. C
12. J
Matching II
1. E
2. L
3. I
4. G
5. F
6. H
7. K
8. A
9. D
10. B
11. J
12. C
13
Chapter 24
Critical Thinking
Some people with diabetes take regular insulin shots to maintain a
steady blood sugar level. However, it can take some practice to
learn to regulate the amount and timing of insulin intake versus
food intake, as well as how different activities affect blood sugar
levels and insulin absorption. In this case, it is possible that the
client had taken more insulin than her body needed, resulting in
low blood sugar levels. Because some clients may have recently
started on insulin, they may also be unfamiliar with the effects of
massage on the body’s insulin absorption. In a relatively mild
situation, a person can counteract this effect by ingesting
something sugary, such as eating hard candies or drinking fruit
juice. Be sure to have these items readily available for just such
situations. A more severe situation is a medical emergency
requiring immediate assistance.
Chapter 25
Critical Thinking
The placenta is a spongelike filtering organ that allows only
small molecules to pass through. It allows for the exchange
of nutrients and wastes between the developing fetus and
the mother. Drugs, alcohol, viruses, and other toxic
substances can pass through the placenta from the mother’s
blood. This can produce devastating effects on the unborn
child, such as Fetal Alcohol Syndrome, low birth weight,
mental retardation, cerebral palsy, developmental delays,
behavioral and learning problems, and deformities.
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
Matching I
1. K
2. E
3. I
4. D
5. B
6. J
7. A
8. C
9. F
10. H
11. L
12. G
Matching I
1. C
2. G
3. F
4. K
5. E
6. A
7. L
8. D
9. I
10. H
11. B
12. J
Matching II
1. G
2. L
3. F
4. B
5. A
6. C
7. E
8. J
9. I
10. K
11. H
12. D
Matching II
1. L
2. J
3. A
4. I
5. D
6. H
7. K
8. G
9. C
10. E
11. F
12. B
14
Chapter 26
Critical Thinking
Students should be able to recognize that the cardiovascular
system is essential for the distribution of blood throughout the
body. They must realize that external pressure from massage can
significantly impact the internal functioning of the cardiovascular
system. Increasing circulation, which is a desired effect of massage
for healthy clients, could have negative consequences for clients
with some conditions. Also, vigorous techniques can
unintentionally dislodge a blood clot in susceptible persons.
Chapter 27
Critical Thinking
Lymph nodes collect and filter foreign substances, such as
bacteria and viruses, from lymph. When lymph nodes are
working harder than usual to combat invaders, lymph can
back up (edema) and the nodes can become enlarged. There
are three main clusters of nodes, cervical, axillary, and
inguinal; swollen nodes in one region can indicate a local
infection. Because the nodes in all three areas are engaged,
your client could have a systemic infection, such as a cold
or mononucleosis. Massage is contraindicated for some
infections and conditions, so you should ask your client
whether he or she is ill or is having a flare-up. (You should
also protect your own health against contagious conditions.)
However, massage is beneficial for other types of edema.
Obtain a physician’s clearance, if necessary, before
resuming massage treatments. If you do continue the
massage, remember that swollen lymph nodes can be
tender, so you should inquire about your client’s comfort as
you work near these areas while avoiding the enlarged node
unless you possess advanced training in this area.
Chapter 28
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
Matching I
1. H
2. D
3. G
4. L
5. I
6. B
7. E
8. J
9. C
10. A
11. F
12. K
Matching I
1. K
2. E
3. H
4. J
5. C
6. G
7. L
8. B
9. I
10. A
11. F
12. D
Matching I
1. H
2. F
3. A
4. J
5. G
6. D
7. K
Matching II
1. K
2. E
3. I
4. J
5. A
6. G
7. L
8. C
9. H
10. F
11. D
12. B
Matching II
1. G
2. B
3. H
4. L
5. C
6. I
7. D
8. K
9. A
10. J
11. F
12. E
Matching II
1. E
2. I
3. L
4. B
5. D
6. F
7. K
15
Critical Thinking
Some pathologies may contraindicate massage therapy. The client
might be contagious or have a condition where symptoms would
worsen by massage therapy. Some conditions require immediate
medical treatment. Allergies must also be taken into consideration.
Some clients might have chronic conditions for which massage
would cause pain. On the other hand, massage is an appropriate
and effective response to other conditions. Massage can contribute
to relaxation and can improve pulmonary functions.
Chapter 29
Critical Thinking
Foods can interact in the gastrointestinal (GI) tract to enhance or
counteract the absorption process. For example, calcium is much
better absorbed when ingested with vitamin D. Natural laxatives,
such as flaxseed oil and foods high in fiber, reduce intestinal
transit time, so they reduce overall nutrient absorption. (Some
students might mention other food-combining theories and
practices, such as eating protein separate from starch, and fruits
and simple sugars separate from all other foods.)
Chapter 30
Critical Thinking
Except in cases of urinary tract, bladder, or kidney infection, urine
does not usually contain bacteria. (Students will probably be
familiar with the “clean catch” procedures used to obtain a urine
specimen uncontaminated by bacteria from the external genitalia.)
The odor of stale urine is caused by contamination and
decomposition after excretion.
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
Answers to End-of-Chapter Test Your Knowledge activities
8. I
9. E
10. C
11. B
12. L
8. J
9. C
10. H
11. A
12. G
Copyright © 2012, 2007, 2003, 1999 by Saunders, an imprint of Elsevier Inc.
16