Massage Techniques seen in the Athletic Training Facility and their Effects

1. Massage Techniques seen in the Athletic Training Facility and their Effects By Justin Woodward

2. History of Massage • Massage has been used as a treatment for Illnesses and Injuries since 3000 B.C. • Was first used in parts of Egypt and Asia • In 1893 Albert Hoffa wrote the Technikder Massage • This outlined the Hoffa Massage in detail. • Hoffa Massage consists of: Effleurage, Petrissage, Tapotment and Vibrations or Effleurage to end it.

3. Physiological Effects Massage is defined as “the systematic manipulation of the body’s tissues.” – Chad Starkey Effects of Massage can be split into Reflexive and Mechanical Effects

4. Physiological Effects • Reflexive Effects- Can effect nerves (sensory and motor) locally and cause some effect on the central nervous system • Mechanical Effects- Changes in tissues using direct mechanical force • As Mechanical Effects increase, Reflexive effects decrease

5. Reflexive Effects • Effects on Pain- • Can modulate pain through Gate Theory and Beta Endorphin Pain control • Effects on Circulation • Some studies suggest that massage can increase blood flow and lymphatic flow- studies are not empirical

6. Reflexive Effects • Effects on Metabolism • Massage has no effect on metabolism • According to Martin et al. active recovery is much more effective in the removal of Lactate from blood when compared to sports massage • The reflex stimulus causes sedation and relieves tension • Slower, Lighter strokes will cause greater reflexive stimulus

7. Mechanical Effects • Effects on Muscle • Increase Range of Motion • Removal of Adhesions • Mechanical stretching of muscular tissue and fascia • Possible increase in Blood Flow • No increase in muscle strength • No decrease in muscle fatigue • Can decrease the severity of DOMS • Increase in Venous Return

8. Mechanical Effects • Effects on Skin • Increase in Temperature • Possibly increase blood flow • Fast, deep strokes has been shown to have greater effect on blood flow • Assist in the removal of Adhesions between skin and subcutaneous layer

9. Psychological Effects • Massage can improve mood after intense exercise or injury • Can lead to more compliance during rehabilitation • Improved Patient-Clinician Relationship • Due to the One-on-one nature of massage, the clinician must spend individual time with the patient • Many athletes believe that massage will assist them in the healing process, and will see improvements through suggestion. • Massage can reduce anxiety

10. Massage Guidelines and Considerations • Essentials to Proper Massage • Good Knowledge of Anatomy • Thorough understanding of the Principles of Massage • Knowing the athletes injury

11. Clinician and Patient Positioning • Clinician- • Should be in a comfortable fairly upright position with weight distributed evenly • Clinician should shift weight to cause most of the mechanical stimulus to prevent fatigue • Patient- • Should be in a comfortable, relaxed, well supported position • Should have injured area exposed and draped any other area which it is necessary

12. Precautions • Nails should be trimmed • To avoid scratching or causing lacerations • Remove all rings, watches, or wrist jewelry • Hands should be warm • Lubricant should be used, especially for effleurage

13. Contraindications • Any condition in which massage may aggravate it: • Infection • Malignancies • Skin diseases • Blood Clots • Irritations/rashes • Lesions • Fractures

14. Massage Techniques Effleurage Petrissage Tapotment Vibration Friction Massage Myofascial Release Acupressure

15. Effleurage • Stroking/Shingling Technique • Every massage should start and end with effleurage • We want to always have one hand on the patient • Want to keep a consistent, rhythmic pattern • Want to start with light pressure and gradually increase pressure • The firmer the pressure the less reflexive effects

16. Effleurage • Effleurage should be done distal to proximal • Especially if edema reduction is the goal • Patient should also be in a gravity assisted position for edema reduction

17. Practice Break up into Pairs and Practice it yourselves. Do Effleurage for 2 minutes then switch with your partner

18. Petrissage • Kneading Technique- pinching and rolling the tissue between fingers • Can also can use 1 or 2 hands, grab, roll, lift or apply pressure • Move distal to proximal • Less lubricant is needed for this technique to make it easier to grab skin • Great for removing/preventing adhesions

19. Practice Break up into Pairs and Practice it yourselves. Do Petrissage for 2 minutes then switch with your partner

20. Tapotment • Percussion Technique- hands should be loose and tap the skin • Stimulates Peripheral Nerves • Types- • Cupping • Hacking • Beating • Pinching

21. Practice Break up into Pairs and Practice it yourselves. Do Tapotment for 2 minutes then switch with your partner

22. Vibration A fine, small movement, made by hand or fingers placed firmly against a part causing a part to vibrate Hands should remain in contact and a rhythmical trembling movement will come from arms Less skilled or inexperienced clinicians may want to use a vibration tool to administer this part of the massage

23. Practice Break up into Pairs and Practice it yourselves. Do Vibration for 1 minutes then switch with your partner May be difficult, don’t worry if you don’t get this at first, it takes a very skilled hand to do this technique

24. Friction Massage • Used to treat chronic inflammation of tendons • Rub perpendicular to the fibers • Generally done for 5-10 minutes • Will be painful • Objective it to re-start the healing process

25. Myofascial Release Technique Relieves soft tissue from abnormal hold of fascia Cross Hand Technique- cross hands and apply pressure in opposite directions Can also apply pressure to the muscle and have the patient contract muscle forcing the fascia to stretch and release from the muscle

26. Practice • Break up into Pairs and Practice it yourselves. • Do Myofascial Release for 2 minutes then switch with your partner • Do Cross Hand Method • Do Pin and Contract Method

27. Acupressure • An old Chinese based method to treat aggravated trigger points • Find trigger point nodule • Apply firm pressure in a circular motion • Can use finger, knuckle, or elbow • Will cause pain and numbing effect • Treatment usually lasts 1-5 minutes per trigger point

28. Questions

29. References Hemmings B. Physiological, psychological and performance effects of massage therapy in sport: a review of the literature. Physical Therapy in Sports. November 2001; Vol. 2(4): 165-170 Martin et al. The Comparative Effects of Sports Massage, Active Recovery, and Rest in Promoting Blood Lactate Clearance After Supramaximal Leg Exercise. Journal of Athletic Training. January-March 1998; Vol. 33(1): 30-35 Moraska A. Sports Massage: A Comprehensive Review. Journal of Sports Medicine and Physical Fitness. September 2005; Vol. 45(3): 370-380 Zainuddin Z et al. Effects of Massage on Delayed-Onset Muscle Soreness, Swelling, and Recovery of Muscle Function. Journal of Athletic Training. July-Sept 2005; Vol. 40(3): 174-180 Starkey C. Therapeutic Modalities. 3rd Edition. Therapeutic Massage. 2004; 16: 295-307 Houglum P. Therapeutic Exercise for Athletic Injuries. Manual Therapy Techniques. 2001; 6: 159-172