How To Ace Your CMTO OSCE Exam: Treatment Station

How To Ace Your CMTO OSCE Exam: Treatment Station

Jul 05, 2024

In this station, you’ll need to conduct a focused treatment based on the information randomly selected in the stem. Unless stated otherwise, informed consent is not required for this station. I cant stress t this enough READ the stem thoroughly and don’t over think it. Everything you need to know is on the stem, the rest is literally in your hands.

Massage Techniques

  1. Effleurage

    • Use: Warm-up, relaxation, and assessment of tissues.
    • Effects: Increases blood circulation, warms tissues, and provides a soothing effect.
    • Contraindications: Open wounds, acute inflammation, and severe varicose veins.
    • How to Perform: Use long, gliding strokes with the palms of the hands.

  2. Petrissage

    • Muscle Squeezing
      • Use: Breaks down adhesions, increases circulation.
      • Effects: Reduces muscle tension, improves blood and lymph flow.
      • Contraindications: Acute muscle tears, severe varicosities.
      • How to Perform: Lift and squeeze the muscle tissue with a kneading motion.
    • Stripping
      • Use: Treats tight muscles and trigger points.
      • Effects: Lengthens muscle fibers, releases adhesions.
      • Contraindications: Acute injuries, inflammation.
      • How to Perform: Apply deep pressure along the muscle fibers.
    • Wringing
      • Use: Reduces tension and improves mobility.
      • Effects: Increases circulation and flexibility.
      • Contraindications: Fragile skin, acute injuries.
      • How to Perform: Twist the muscle tissue as if wringing out a towel.
    • Kneading
      • Use: Softens tissues, reduces tension.
      • Effects: Enhances blood flow, promotes relaxation.
      • Contraindications: Acute injuries, severe edema.
      • How to Perform: Use circular motions to knead the muscle.

  3. Ischemic Compressions

    • Use: Deactivate trigger points.
    • Effects: Reduces pain and muscle spasms.
    • Contraindications: Acute injuries, infection, fragile blood vessels.
    • How to Perform: Apply sustained pressure directly to the trigger point.

  4. Fascial Work

    • Use: Release fascial restrictions.
    • Effects: Improves mobility and reduces pain.
    • Contraindications: Acute inflammation, recent fractures.
    • How to Perform: Use slow, sustained pressure to stretch the fascia.

  5. Trigger Point Release

    • Use: Deactivate trigger points.
    • Effects: Reduces pain and improves function.
    • Contraindications: Acute injuries, infection.
    • How to Perform: Apply pressure to the trigger point until it releases.

  6. Stroking

    • Use: Relaxation, sensory feedback.
    • Effects: Soothes the nervous system, promotes relaxation.
    • Contraindications: Open wounds, severe varicosities.
    • How to Perform: Use light, gentle strokes over the skin.

  7. Friction

    • Use: Breaks down adhesions and scar tissue.
    • Effects: Increases mobility and reduces pain.
    • Contraindications: Acute inflammation, fragile skin.
    • How to Perform: Apply deep, circular or transverse pressure to the tissue.

  8. Vibrations

    • Fine Vibrations
      • Use: Relaxation, pain relief.
      • Effects: Soothes the nervous system.
      • Contraindications: Acute injuries, severe pain.
      • How to Perform: Apply gentle, rapid oscillations with fingers.
    • Coarse Vibrations
      • Use: Stimulates tissues, relieves pain.
      • Effects: Increases blood flow, reduces muscle tension.
      • Contraindications: Acute inflammation, fragile blood vessels.
      • How to Perform: Apply stronger, more pronounced oscillations.
    • Static Vibrations
      • Use: Pain relief, relaxation.
      • Effects: Soothes the nervous system.
      • Contraindications: Acute injuries, severe pain.
      • How to Perform: Hold the vibration in one spot.
    • Running Vibrations
      • Use: General relaxation.
      • Effects: Soothes the nervous system, reduces tension.
      • Contraindications: Acute injuries, severe pain.
      • How to Perform: Move the vibrating hand along the muscle.

  9. Tapotement

    • Tapping
      • Use: Stimulates tissues, promotes circulation.
      • Effects: Invigorates the body, increases blood flow.
      • Contraindications: Bony areas, acute inflammation.
      • How to Perform: Lightly tap with the fingertips.
    • Hacking
      • Use: Stimulates tissues, improves muscle tone.
      • Effects: Invigorates the body, increases blood flow.
      • Contraindications: Bony areas, acute inflammation.
      • How to Perform: Use the ulnar border of the hands in a chopping motion.
    • Cupping
      • Use: Stimulates tissues, clears congestion.
      • Effects: Increases blood flow, releases mucus in respiratory conditions.
      • Contraindications: Over the spine, acute inflammation.
      • How to Perform: Form a cup shape with your hands and perform a rhythmic, clapping motion.
    • Beating
      • Use: Deep muscle stimulation.
      • Effects: Increases blood flow, reduces muscle tension.
      • Contraindications: Over the spine, acute inflammation.
      • How to Perform: Use a fist in a pounding motion.

  10. Rocking

    • Use: General relaxation.
    • Effects: Soothes the nervous system, promotes relaxation.
    • Contraindications: Nausea, vertigo.
    • How to Perform: Gently rock the client's body or limbs.

  11. Shaking

    • Use: Reduces muscle tension.
    • Effects: Promotes relaxation and increases mobility.
    • Contraindications: Acute injuries, severe pain.
    • How to Perform: Shake the muscle group or limb gently.

  12. Passive Stretching

    • Use: Increases flexibility and range of motion.
    • Effects: Lengthens muscles, reduces tension.
    • Contraindications: Acute injuries, hypermobility.
    • How to Perform: Move the client's limb into a stretch without their assistance.

  13. Joint Play

    • Use: Improves joint mobility.
    • Effects: Increases range of motion and reduces pain.
    • Contraindications: Joint instability, acute inflammation.
    • How to Perform: Apply gentle, oscillatory movements to the joint.

  14. Muscle Approximation

    • Use: Reduces muscle spasms.
    • Effects: Shortens the muscle, promoting relaxation.
    • Contraindications: Acute injuries, hypermobility.
    • How to Perform: Bring the muscle attachments closer together.

  15. Manual Lymphatic Drainage

    • Use: Reduces swelling and promotes lymph flow.
    • Effects: Decreases edema, enhances immune function.
    • Contraindications: Acute infections, congestive heart failure.
    • How to Perform: Use light, rhythmic strokes towards the lymph nodes.

  16. PNF (Proprioceptive Neuromuscular Facilitation)

    • Hold Relax
      • Use: Increases flexibility.
      • Effects: Relaxes and lengthens muscles.
      • Contraindications: Acute injuries, severe pain.
      • How to Perform: Hold the muscle in a stretched position, then have the client contract against resistance.
    • Contract Relax
      • Use: Improves range of motion.
      • Effects: Enhances flexibility and muscle relaxation.
      • Contraindications: Acute injuries, severe pain.
      • How to Perform: Stretch the muscle, then have the client contract and relax it.
    • CRAC (Contract Relax Antagonist Contract)
      • Use: Further increases range of motion.
      • Effects: Maximizes flexibility.
      • Contraindications: Acute injuries, severe pain.
      • How to Perform: Stretch the muscle, contract it, then have the client contract the opposing muscle.

Principles of Massage

  1. Superficial, Deep, Superficial

    • Explanation: Start with light strokes to warm up the tissues, proceed to deeper techniques for therapeutic effects, and finish with light strokes to soothe and relax.
    • How to Perform: Begin with effleurage, move to deeper petrissage or friction, and end with effleurage or gentle stroking.

  2. General, Specific, General

    • Explanation: Begin with broad, general strokes to assess and warm up the area, focus on specific areas needing treatment, and finish with general strokes to integrate the treatment.
    • How to Perform: Start with effleurage over the entire back, focus on specific knots with ischemic compression, and end with general effleurage.

  3. Proximal, Distal, Proximal

    • Explanation: Start the massage closer to the heart to promote circulation, move towards the extremities, and finish near the heart.
    • How to Perform: Begin with effleurage on the upper thigh, move down to the calf, and end back at the thigh.

  4. Peripheral, Central, Peripheral

    • Explanation: Begin with strokes on the periphery of the problem area, move to the central part of the issue, and finish with strokes on the periphery again.
    • How to Perform: Start with effleurage around the edges of a sore shoulder, work on the central trigger points, and end with effleurage around the shoulder again.

Practice Case Example

Stem: Client presents with shoulder pain and restricted range of motion.

Steps:

  1. Effleurage to warm up the shoulder area.
    • "I’ll start with some gentle strokes to warm up the muscles."
  2. Petrissage (kneading and muscle squeezing) on the deltoid and upper trapezius.
    • "Next, I’ll apply deeper pressure to release muscle tension."
  3. Ischemic Compressions on identified trigger points in the shoulder.
    • "I’ll apply sustained pressure to these tight spots to help release them."
  4. Passive Stretching of the shoulder.
    • "I’ll gently move your arm to stretch the shoulder muscles."
  5. Trigger Point Release on the infraspinatus and teres minor.
    • "I’ll use pressure to release specific tight areas in the shoulder."
  6. Finish with Effleurage to soothe the treated area.
    • "Finally, I’ll use light strokes to calm the muscles and improve circulation."

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