Therapeutic Massage

1. Therapeutic Massage Chapter 16

2. General Overview

3. Historical Perspective • Dating back to the ancient Olympians • Late 1980’s • American Massage Therapy • 1992 • National Certification Examination for Therapeutic Massage and Bodywork

4. Purpose • Manipulates the the body’s tissues to: • Reduce muscle spasm • Promote relaxation • Improve blood flow • Increase venous drainage • Broad range of massage theories, techniques, and effects

5. Reflexive Effects • On Pain • Gate control theory • Endogenous Opiates release • On Circulation • Somatosympathetic reflex - probably does not occur with massage, since massage is passive. • Axonal reflex occurs when cutaneous afferent information travels antidromically and produces a local vasodilation

6. Reflexive Effects • On Metabolism • Does not alter metabolism significantly • On Motor Neuron Activity • There is an inhibition of the spinal motor neuron excitability during a massage. It is specific to that muscle with no lingering effects

7. Mechanical Effects • stretching and mobilizing tissues • mechanically increase blood flow and venous return of that muscle

8. Circulation • Light exercise is more effective in increasing blood flow than massage • Cellular metabolism

9. Effects on Range of Motion (ROM) • Increase ROM short-term, but no Long-term effects

10. Effects on the Recovery of Muscle Function • Massage appears to have no benefit on recovery of muscle function in the following situations: • muscle damage caused by eccentric overload. • recovery of post-exercise muscle strength. • reduction of delayed onset muscle soreness (DOMS). • rate of recovery of muscle function following anaerobic work.

11. Psychological • You communicate compassion, concern, anger, sensual, or other emotions through touch.

12. Basic Strokes: Effleurage Pétrissage Friction Tapotement Vibration Myofascial Release: J-Strokes Focused Stretching Skin Rolling Arm Pull / Leg Pull Diagonal Release Types of Massage

13. Different types of strokes • Effleurage (stroking) • Superficial or Deep • Petrissage (kneading) • Friction • Transverse or Longitudinal • Vibration • Tapotement • Percussion/slapping/hacking/beating

14. Effleurage • “Stroking of the skin” • Spread massage lubricant • Use at the beginning and end of the massage • Superficial: • slow strokes for relaxation • Deep: • Elongates muscle fibers • Stretches fascia • Forces fluids in the direction of the stroke • towards the heart

15. Pétrissage • “Lifting and kneading” • Frees adhesions: • Stretches and separates muscle fiber, fascia, and scar tissue • If only technique used, it may be performed without the use of lubricant

16. Friction • “Deep pressure” • Circular: • Use a circular motion with thumbs, elbow, or a commercial device • Transverse Friction: • The thumbs or fingertips stroke in opposite directions • Effects muscle mobilization, tissue separation, and trigger points

17. Tapotement • “Tapping or pounding” of the skin • Variations: • Hacking • Cupping • Pincement (pinching) • Rapping • Tapping • Performed with a light, fast tempo • Promotes muscular and systemic relaxation and desensitization of irritated nerve endings

18. Vibration • “Rapid Shaking” • Rolling a limb between hands (arm/leg) • Increases blood flow and provides systemic invigoration of tissues • Mechanical devices available

19. Myofascial Release • Stroking and stretching of tissues: • Relax tense tissues • Release adhered tissues • Restore tissue mobility • Clinician receives cues and feedback from the patient’s tissue • This indicates the appropriate strokes and stretches • Specialized training in myofascial release techniques is needed to become proficient in these skills

20. J-Strokes • One hand places the adhesion on stretch • Other hand’s 2nd and 3rd fingers stroke in the opposite direction forming a ‘J’ • Mobilize scar tissue

21. Focused Stretching • Heel of one hand in the area of restriction • Heel of other hand crossed in front • Stretch the tissue using slow, deep pressure • Reduces superficial or deep adhesions

22. Skin Rolling • Use fingers and thumb to lift and separate the skin from the underlying tissue • Similar to Pétrissage • Roll skin between fingers noting restriction • Lift skin and move it in the direction of the restriction • Reduces superficial myofascial adhesions

23. Arm Pull/Leg Pull • Arm pull (example): • Grasp extremity proximal to wrist • Apply gentle traction that is in line with anterior deltoid • Continue to abduct 10-15 degrees until full abduction is reached • Stretches large areas of fascia

24. Physiological Effects • Cardiovascular • Increase blood flow, histamine release, and temperature • Decreased heart rate, respiratory rate, and blood pressure • Neuromuscular • Increase flexibility, decrease neuromuscular excitability (relaxation), edema reduction, and stretch muscle and scar tissue • Pain • Activate spinal gate and the release of endogenous opiates • Psychological • Reduces patient anxiety, depression, and mental stress

25. Increase blood flow Facilitate healing Increase range of motion Remove edema Alleviate muscle cramps Stretch scar tissue/adhesions Decrease pain Indications

26. Contraindications • Acute inflammatory conditions • Severe varicose veins • Open wounds • Skin infections • Failed or incomplete fracture healing • Thrombophlebitis

27. Preparation • Table • Linens and pillows • Massage lubricant • Patient position • Masseuse position

28. Traditional Massage • Apply massage medium with light, slow • Build to deeper effleurage • Pétrissage • Wipe medium before applying deep friction (if applicable) • Reapply pétrissage and deep effleurage • End with light effleurage

29. Edema Reduction Massage

30. Preparation • Elevate the body area • Apply massage lubricant to the skin • Clinician is positioned distal to the extremity

31. Stroke Sequence • Begin proximal to the edematous area • Long, slow, deep strokes towards the torso • Move starting point slightly distal every fourth or fifth stroke • When the starting point moves distal to the edema, begin working back towards the starting point

32. Termination • Remove medium • If appropriate: • Active range of motion exercises • Compression wrap • Encourage patient to drink water to assist in flushing metabolic waste

33. Application • Soft Tissue Healing • Injury • Protect • Inflammatory Phase • Effleurage (Lymphatic) massage • Light petrissage • Avoid friction massage

34. Application • Fibroblastic-Repair Phase • Effleurage and petrissage to reduce edema • Friction to help tension the collagen for proper alignment, thus preventing adhesions. • Maturation-Remodeling Phase • Patient education • Pain Cycle

35. Pain Cycle

36. Chronic Injury Friction Petrissage Effleurage (lymphatic) Application

37. (Fritz, 1995)

38. (Fritz, 1995)

39. Indications & Contraindications • Indications • Patients with adhesions, edema, muscle spasm, bursitis, tendinitis, tenosynovitis, strains, and sprains. • Contraindications • Patients with myositis ossificans, thrombosis or embolism, severe varicose veins (caution), acute phlebitis, cellulitis, synovitis, abscesses, shin injections, and massage of a cancerous site.