Therapeutic Massage

1. Therapeutic Massage Chapter 16

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

3. 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

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

5. 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

6. 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

7. Friction • “Deep pressure” • Effects muscle mobilization, tissue separation, and trigger points • Two types: • Circular • Transverse

8. Circular Friction Massage • Use a circular motion • Thumbs • Elbow • Commercial device

9. Transverse Friction Massage • Strokes perpendicular to tissue fibers • The thumbs or fingertips stroke in opposite directions

10. Tapotement • “Tapping or pounding” of the skin • Variations: • Hacking • Cupping • Pincement (pinching) • Rapping • Tapping

11. Tapotement Technique • Performed with a light, fast tempo • Promotes muscular and systemic relaxation and desensitization of irritated nerve endings

12. Vibration • “Rapid Shaking” • Increases blood flow and provides systemic invigoration of tissues • Mechanical devices available

13. 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

14. 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

15. 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

16. 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

17. 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

18. Diagonal Release • One clinician grasps the leg proximal to talocrural joint • Other grasps the opposite arm proximal to wrist • Keep extremities horizontal to each other • One moves the limb until adhesions are felt while the other stabilizes the extremity • Stretch large area of fascia

19. 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

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

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

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

23. 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

24. Edema Reduction Massage

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

26. 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

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