HACSATT – Hall’s Anatomical Common Sense Approach To Treatment

First published 28 August 2019

With any remedial massage, I apply what I call my Hall’s Anatomical Common Sense Approach To Treatment – or HACSATT.

HACSATT is an overall system, not a specific technique, I’ve developed over my 33 years (in 2024) as a massage therapist, and particularly in the 25+ years since I’ve focused on remedial massage.

It really is just a simple approach any hands-on physical bodywork therapist could apply in virtually any common muscle or joint pain treatment, for headaches and migraines and in preparation for and recovery from exercise, fitness, sporting and recreational activities.

It often means a significant or least noticeable difference, or even a complete fix, can be achieved in just ONE SESSION.

Hall’s Anatomical Common Sense Approach to Treatment is exactly what the name implies – a simple COMMON SENSE APPROACH to identifying and treating the real ANATOMICAL causes and contributing factors to your pain areas, rather than just focusing on the symptoms.

HACSAT primarily involves:

  • Spending time TALKING to you about your problem areas, medical/work/lifestyle history, etc. – not just getting you to fill in a form and taking a glance at that to get your information and background.
  • Explaining various body soft tissue and joint interactions in some detail and how they might be contributing to the problem areas.
  • Doing a postural assessment to identify ACTUAL problem areas before you get on the table.
  • Further detailed checks (eg feet, hip and jaw alignment) once on the table, and explaining what I’m doing.
  • Giving a THOROUGH feet to head REMEDIAL massage with focus on areas that need it the most and including various stretches.
  • Rechecking things (eg jaw) that have shown to be out of alignment.
  • Giving advice on basic stretches, exercises and any orthotic support that may help with current problems and avoid future issues.

HACSATT is ideal for COMMON muscle and joint aches and pains, headaches and migraines. These include things like carpal tunnel, tennis elbow, wry neck, basic sprains and strains, or just bending down to pick up a paperclip and not being able to stand straight again.

With immediate or acute pain – as in days or hours – after a specific INJURY (like a torn muscle or ligament), SURGERY, other TRAUMA, or DISEASE, the initial assessment, recovery and rehabilitation is primarily the role of physiotherapists.

However, in many such cases, the compensatory effects that injury or surgery has on a range of other muscles and soft tissue are usually overlooked. This often results in COMMON pain also developing in those areas.

It can slow the healing of the original injury to the point where the pain may become “chronic” after three to four months. Chronic pain is a self-generating chemical neuro-transmitter process and does not rely on the status of the original injury (eg a muscle tear that already should have healed itself).

HACSATT considers BASIC anatomy and how muscles and other soft tissue and areas of the body interact with each other. It is knowledge ANY person SHOULD have with a Diploma of Remedial Massage (or equivalent) or a university degree in hands-on physical bodywork therapy such as physiotherapy, chiropractic or osteopathy.

Most importantly, it asks the question, “Why?” If you experience COMMON pain in a particular area, WHY is that pain there? Is there a simple chain of anatomical events in areas you might not feel sore that are part of the problem? If there are no obvious answers, perhaps it could be a medical condition like infection, gallbladder, kidney or liver issues or cancer that manifests itself with muscular pain (where medical advice is needed).

You may be aware of a particular event (eg heavy lifting, sleeping uncomfortably, or a big session of gardening) following which your pain developed. But in many cases, that event just may have been the “straw that broke the camel’s back” and was too much for an area that was already tight from other factors.

You may know, or have been told by another therapist, that certain muscles, tendons or ligaments are tight, stretched, strong, weak, inactive, “not firing,” hyperextended, etc. But “WHY?”

There may be some obvious answers, but it is the less obvious and often very simple anatomical ones that are often the key.

Even though I always give you a comprehensive massage, I can put the focus on the areas that mainly need the work – not just where you have told me you are sore.

In fact, working just in those areas is likely to make the problems worse or prolong them. The pain you feel is inflammation. Just working in that area could increase inflammation. Don’t accept that just because any type of physical therapist is causing you pain in your problem area that it must be doing you good. It could make it worse!

An important aspect of HACSATT is that I actually sit down and TALK to you before the massage. I don’t just hand you a form to fill out. And I give you that extra time FREE so it doesn’t reduce the time you have for the actual massage on the table.

Part of that CONVERSATION is not only to get any relevant medical history, but also a bit about your lifestyle and work history, previous injuries, types of treatment, etc, as well as details of your problem areas.

I don’t need to know WHERE you work, but the TYPE of work you not only do now but in the past can provide some vital clues. For example, you may be in an administration or supervisory type job now (eg involving a lot of sitting at a computer), but in the recent past you may have been a tradie, cleaner, factory production line worker, soldier, military helicopter pilot, etc, where muscles you used regularly then could have contributed to your current problems.

Similarly, with your lifestyle: Are you a keen gardener, sportsperson, exercise enthusiast, gym junkie, boatie, grey nomad, four-wheel-driver, kite-surfer, etc? Those activities can help identify potential contributors to your problem areas.

Another aspect of HACSATT is my FIVE-STAR (as in “top-notch”) postural assessment that I’ve also developed from a good knowledge of anatomy combined with many years of experience.

Within about 30 seconds, I can identify virtually every muscle in your body that will be sore or tight, weak or stretched BEFORE you even disrobe to get on the table. But with your first visit, I’ll explain what I’m looking at and why – so that takes a bit longer.

Below are just three of many common basic scenarios where HACSATT is ideal. These scenarios assume there are no known specific injuries or causes. However, some injury may have occurred weeks, months or years prior but was not treated at all or not treated properly at the time.

Obesity also may be an issue, particularly with joint pain. But, generally speaking, physical therapy clients in pain want some immediate hands-on treatment and potential relief, not a discussion about their weight or just to be given a series of exercises, to do in their own time, they often can’t achieve because of their weight and pain and the de-motivating factors they create.

KNEE PAIN

(Even with other factors like a torn Meniscus or Baker’s Cyst or teenage growth plate issues).

The obvious treatment would be looking for and treating tightness or weakness in the LEG muscles, tendons and ligaments going across or attaching near THAT knee area. Some therapists might also look at the hips, including the buttocks muscles and possibly check how the Patella (kneecap) is “tracking” (eg, pulling to one side).

With HACSATT:

  • What is happening with your OTHER knee is also critical. Any problem in that leg and knee, although it may not be painful, may cause compensatory effects on your sore knee.
  • Your Tibia bone in the lower leg and Femur in the thigh are meant to rotate in synch at the KNEE JOINT. The amount and direction of their rotation is determined by the way your FEET strike the ground, so feet alignment is critical. I check and give advice on foot alignment and treat all the muscles that move the feet.
  • Depending on the Tibia/Femur rotation and via some big ligaments in the hip, the Femur can cause muscle imbalances and misalignment of the hip.
  • Muscles/tendons across the knee joint will be out of balance if one hip is higher than the other and/or there is an anterior (forward) and/or posterior (backwards) tilt. Realigning the HIPS, including releasing Hip Flexor and Gluteus (buttocks) muscles, is essential. I can realign the hips totally painlessly and without any forced manipulation/”adjustment” in about two minutes using my HACSATT technique. (This often also negates what you may have been told about having one leg shorter/longer than the other).
  • Tightness in your shoulder blade and chest areas will have an effect on spinal rotation, which can also contribute to one hip being higher than the other.

They are just SOME of the factors I consider and treat with HACSATT.

HEADACHES / MIGRAINES

The obvious treatment is to massage around the neck and top of the shoulder area and base of the skull to loosen tight muscles, and possibly some scalp massage. Some therapists also might work down into the shoulder blade area.

With HACSATT:

  • The first thing I check is if you have bent toes, high or low arches or your ankles roll in or out. The alignment of your feet and the way they strike the ground have a bearing on overall postural alignment and muscle imbalances right up into the shoulders, neck and head.
  • Any nerve in the body can be impinged at the jaw, via the Dura Mater, the outer of three Meninges (membranes) around the brain and spinal cord through which all nerves must pass. An impinged nerve may have an effect on muscles or organs that may cause or contribute to headaches or migraines. It is vital to check and ensure the jaw is properly aligned.
  • There is a close relationship between nerves in the occipital area (base of skull) and back of the eyes (as in headache pain). Some groups of muscles/tendons attaching to the base of the skull also attach to the hips, so imbalances in those muscles anywhere along the spine need to be addressed.
  • Poor posture – particularly through occupational activity – is often blamed for headaches and migraines and is often a contributing factor. But various aspects that help create poor posture, including tightness in the Pectoralis muscles in the chest, Hip Flexors across the hips and Latissimus Dorsi (Lats) in the back, are often overlooked. I don’t.

CARPAL TUNNEL

The nerve associated with carpal tunnel pain is the Median nerve. It can be impinged in the “carpal tunnel” in the wrist because of tight or inflamed forearm muscles and their tendons which also pass through the tunnel.

The obvious treatment applied by most therapists is to focus on releasing and/or stretching muscles in the forearm.

(Chiropractors tend to just focus on manipulating/adjusting the neck vertebrae because the Brachial Plexus of nerves, which includes the Median nerve, originates from there).

With HACSAT:

  • The forearm muscles/tendons definitely need to be massaged and stretched in any treatment as carpal tunnel is often the result of repetitive strain injury (RSI) – overuse of particular muscle groups as part of your occupation or lifestyle activities (eg cleaning, data processing, or rowing). A person’s medical, work and lifestyle history could point to that.
  • The Median nerve also may be impinged at the elbow or shoulder or in the NECK around C6/C7, so it is vital to look at ALL those areas and the muscles moving ALL those joints.
  • That includes muscles moving the shoulder blades as restrictions there can affect the movement of the shoulder and therefore the arm at the main shoulder joint.
  • There are TEN joints – five on each of the left and right sides of the body – that move the shoulder. ALL those joints need to be considered. (Eg. with carpal tunnel in the RIGHT hand, it is also necessary to include the Pectoralis Minor muscle in the LEFT chest as that muscle attaches to the left shoulder blade and can restrict movement of both shoulders). The Pec Minor muscle can also impinge the Median nerve (part of the Brachial Plexus) in the top of the chest.
  • The neck is the CERVICAL part of the overall spine. Anything affecting any part of the spine, including in the lower back, also will have an impact on the neck, so muscle balance along the whole spine needs to be considered.

Above are just SOME things I consider in treating any of those problems – and many others.

None of this is ROCKET SCIENCE. It’s just about having sound knowledge of basic anatomy and the various anatomical interactions.

They don’t teach that INTERACTIVITY in any detail in primary or high schools (and, apparently, in Anatomy and Physiology subjects at university – judging by what I’ve been told by many uni students). So, when most people feel sore in a particular area, they immediately assume their pain is just related to where they feel it.

In my opinion, based on long personal experience and what I’ve been told by numerous clients, anatomical COMMON SENSE also is now something largely missing in many hands-on physical bodywork treatments. It could be strongly argued the BUSINESS PLAN – covering costs, making a profit, duration of sessions, return visits, etc, often takes precedence over the actual treatment. That simply means that many areas that SHOULD be treated are ignored. So the “TREATMENT PLAN” you receive is often just another name for the BUSINESS PLAN.

It often results in unnecessary return visits that sometimes continue for much longer and with less success than if no treatment was given at all. Return visits also can quickly drain any entitlement you might have to private health fund rebates.

Consider this: If you have, say, five or six treatments over six or seven weeks, that is roughly the time it might take for even some torn muscles or other problems to correct themselves with no treatment.

Unfortunately, due to the medico-politics of AHPRA (Australian Health Practitioners Regulation Agency – for medical and allied health practitioners), most doctors never suggest to their patients to try remedial massage therapists for common muscle and joint pain issues. Medico-politics prevent them from formally referring massage as a treatment because Medicare can not be claimed with massage.

Remedial therapists are regulated by Government (with things like qualifications, skills, knowledge, insurance, continuing education, first aid, hygiene, ethics, etc) but are not registered with AHPRA or controlled by AHPRA hierarchy. So, in most cases, only the better-informed doctors ever suggest their patients try remedial massage. As a result, many doctors’ patients don’t get the early remedial massage intervention that could save them considerable unnecessary pain and extra costs.

In my opinion, the Defence Department and Department of Veterans Affairs are also wasting hundreds of millions of dollars every year because they do not allow serving members or DVA pensioners to access REMEDIAL MASSAGE as part of their normal health entitlements or with their Gold or White Cards. From what I’ve been told by many Defence members and DVA veterans, it is often ONLY the problem or original injury/surgery area that physical therapists focus on and that often PROLONGS those issues instead of fixing them or reducing the pain.

My final comments in the above five paragraphs are not assumptions on my part. They were prompted by what I’ve been told over many years by thousands of my remedial massage clients who have been to other therapists/practitioners and tried different treatments.

Give me a call on (07) 47746973 or 0438774819 or email me at [email protected] to make a booking. Treatments are by appointment only.

David Hall ©

TOWNSVILLE REMEDIAL MASSAGE THERAPIST

Mount Louisa-based Townsville massage therapist specialising in Remedial Massage for headaches and migraines, all types of muscle and/or joint aches and pains and preparation for and recovery from sporting, exercise and other fitness activities including the range of Defence fitness tests. I guarantee the best value for money remedial massage in Townsville. CALL NOW on (07) 4774 6973 or 0438 774 819 to book an appointment.

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