Therapeutic massage and myofascial mobilization

1. Therapeutic massageandmyofascial mobilization AilaNica J. Bandong, PTRP Instructor Department of Physical Therapy College of Allied Medical Professions

2. Learning objectives At the end of the lecture, the students should be able to: • Discuss therapeutic massage and myofascial mobilization in terms of • physiologic mechanism • benefits for use • indications, contraindications and precautions • Discuss the basic techniques of therapeutic massage and its variants • Enumerate the different techniques of myofascial mobilization • Cite evidence on the effectiveness of therapeutic massage and myofascial mobilization in the given sample cases

3. Massage

4. What is massage? Massage is the therapeutic manipulation of the soft tissues of the body with a goal of normalization of those tissues. Also defined as hand motions practiced on the surface of a living body with a therapeutic goal.

5. Therapeutic effects of massage

6. Goals of massage • Mobilize interstitial fluid • Reduce or modify edema • Increase blood flow • Decrease muscle soreness or stiffness • Alleviate pain • Prevent or eliminate adhesions • Facilitate relaxation

7. Benefits of massage • Relaxation • Pain relief • Reduction of edema • Increase ROM • Metabolically prepare injured or involved muscles for exercise • Encourage confidence of patient • Evaluate patient’s soft tissues • Prepare healthy muscles for strenuous sports activity • Assist the body in recovering from the aftereffects of strenuous activity

8. indications • Tense muscles • Scar tissue • Edema • Pain

9. contraindications • Atrophic skin • Chronic subluxation • Pathologic conditions that could be spread along the skin, through the lymph or the blood. • Area where there is bleeding • Areas of acute inflammation • Phlebitis • Malignancy • Thrombi • Atherosclerotic plaques • Infections • Scars that are not fully healed • Patients on anti-coagulants • Calcified soft tissue • Skin grafts

10. precautions • Disorders of circulatory system • Areas with abnormal sensation • Over recent surgery • Joint replacements • Immunocompromised patients • In the presence of medications that may alter sensation, muscle tone, standard reflex reactions, cardiovascular function, kidney and liver function and personality

11. limitations • Will not reduce obesity • Will not delay loss of muscle strength • Will not hasten recovery of sensation after nerve injury

12. Massagevariants

13. effleurage • Aka stroking massage • Therapist’s hands glide across the skin overlying the muscle being treated • Superficial effleurage • Deep effleurage

14. purposes • Promote relaxation • Note areas of spasm and tightness • Get the therapist’s hands from one problem area to another Accustoms the patient to the touch of the therapist • The only technique that may be employed in instances of extreme soreness • Deep effleurage will provide a passive stretch to given muscles or muscle groups

15. variations • Knuckling • Loose fist • Single/double hand • Three-count stroking of the trapezius • Horizontal stroking • Single/double forearm

16. petrissage • Aka kneading massage • Strokes that attempt to lift the muscle mass and wring or squeeze it gently • Soft tissue is compressed between the hand or fingers of the therapist and gently squeezed as the hands move in a circular motion perpendicular to the direction of compression • Applied vertically in relation to the tissues

17. purposes • Remove waste products • Assist venous return • Effective in decreasing hypertonicity • Beneficial in mechanically softening the superficial fascia

18. variations • Picking- up • Pinching • Rolling • Wringing • Fulling • Milking • Fist kneading • Digital kneading • Alternating two-hand petrissage • Two-finger petrissage • One-hand petrissage • Alternate one-hand petrissage

19. Friction • Aka deep friction massage • Pressure of varying intensities is applied with the ball of the thumb or fingers • Mechanical effect is the application of shear stresses to the underlying tissue specifically at the interfaces (dermis-fascia, fascia-muscle, muscle-bone, scar tissue-bone) • Considered as the most important massage technique • Generally performed for 30 seconds to 10 minutes • No lubricant used

20. Purposes • Massage into deep joint spaces or around bony prominences • Breakdown connective tissue and scar adhesions except deep fibrositis in muscle belly • For pain reduction through mechanism of counterirritation and hyperstimulation analgesia

21. variations • Cross-fiber technique • Storm’s technique • Cyriax’s friction massage

22. tapotement • Aka percussion massage • The skin and muscle are impacted with repetitive compressive blows by the hands

23. Purposes • Used when stimulation is desired • Usually performed in athletes • Can be done to prepare patient for stretching • Used to loosen mucus in the lungs

24. variations • Hacking • Cupping • Fist beating • Beating over palm • Slapping • Finger tapping

25. vibration • A fine tremulous movement made by the hand or fingers placed firmly against a part • Can be used better with electrical vibrator • Follows the path of the nerve in treatment of peripheral neuritis

26. purposes • Used for a soothing effect especially in peripheral neuritis • Can be used to relax antagonist muscle through reciprocal inhibition • Break up monotony of massage • Can be used to loosen consolidations in the lungs

27. Compression • Vertical pressing downward that penetrate the subcutaneous layer • Can be done using the thumb, heel of the hand, palm, fist, knuckles, forearm, elbow • Therapist stays perpendicular with actual compression (~45 to 90 degrees to the body)

28. purposes • Can be used to replace effleurage if gliding strokes can not be performed • Used to tone the muscles • Stimulates the muscle spindle

29. shaking • Relaxes muscle groups or an entire limb • Warms and prepares the body for deeper bodywork • Indicated for extremely tight muscles Rocking • Soothing and rhythmic method used to calm an individual • Up-and-down and side-to-die movement of the body

30. acupressure • Massage forces are applied using the fingers on acupuncture points • Localized finger pressure coupled by circular movements • Pressure is increased until pressure becomes heavy then held constant

31. Reflexology and auriculotherapy • All parts of the body are believed to be mapped to different point on the foot (reflexology) or the ear (auriculotherapy) and massage of a point produces change in the structure mapped to that point.

32. shiatsu • Shi (finger) and atsu (pressure • Japanese form of acupuncture • Pressure is applied at specific points (meridians) • Was first administered by blind clinicians

33. Massage variables • Milieu • Treatment variables • Friction-reducing medium • Rhythm • Rate • Pressure • Direction • Area to be treated • Duration • Frequency • Duration of the program

34. M O B I L I Z A T I O n MyofascIal

35. Myofascial Release Theory • Fascia: three-dimensional web of connective tissue running continuously through the body and superficial to deep without any interruption • Three layers: • Superficial • Deep • Dural

36. Myofascial Release Theory • Functions of Fascia: • Holds tissues together • Separates structures to allow mobility • Protection, nutrition, elimination, and metabolism • Composition: • Collagen • Elastin • Ground substance

37. Myofascial Release Theory • Fascial Restrictions • Cause excessive pressures on pain sensitive areas as well as excessive tensile force on the neuromusculoskeletal sturctures • Sets up the environment for poor cellular efficiency, necrosis, disease, pain , and dysfunction throughout the body • Dysfunction along the deepest/dural fascia can have neurologic effects • A restriction in one area may cause restrictions in other areas of the body

38. Myofascial Mobilization • Also known as trigger point therapy, myofascial release • Since fascia has colloidal properties it can be manipulated and stretched by sustained by pressure • Effect is loosening of fascia  release restrictions or barriers within the fascial layers  relieve symptoms and promote normal quality and quantity of motion

39. Myofascial release • A whole-body “hands-on” approach to evaluation and treatment of the human structure • Evaluation of fascial system • Intervention • Re-evaluation • Incorporated in a comprehensive program that includes modalities, therapeutic exercise, muscle energy techniques, mobilization and manipulation

40. indications • Pain • Movement restrictions • Spasm • Neurologic dysfunction • Sports injuries • Chronic fatigue syndrome • Fibromyalgia • Pediatrics • Scoliosis • Menstrual, pelvic, temporomandibular pain • Headache

41. Contraindications • Malignancy • Febrile state • Acute circulatory condition • Aneurysm • Acute rheumatoid arthritis • Sutures • Healing fracture • Osteoporosis or advanced degenerative changes • Systemic or localized infection • Open wounds • Anticoagulant therapy • Advanced diabetes

42. Basic techniques • Cross-hand techniques • Arm or leg pull (unilateral or bilateral) • Cranial base release • Skin rolling • Scar release • J-stroke

43. Thank you for listening!!! Any questions?

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