Aila Nica J. Bandong, PTRPInstructor
Department of Physical TherapyCollege of Allied Medical Professions
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
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.
Mobilize interstitial fluid Reduce or modify edema Increase blood flow Decrease muscle soreness or
stiffness Alleviate pain Prevent or eliminate adhesions Facilitate relaxation
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
Tense muscles Scar tissue Edema Pain
Malignancy Thrombi Atherosclerotic
plaques Infections Scars that are not
fully healed Patients on anti-
coagulants Calcified soft tissue Skin grafts
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
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
Will not reduce obesity Will not delay loss of muscle
strength Will not hasten recovery of
sensation after nerve injury
Aka stroking massage Therapist’s hands glide across the skin
overlying the muscle being treatedSuperficial effleurageDeep effleurage
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
Knuckling Loose fist Single/double hand Three-count stroking of the
trapezius Horizontal stroking Single/double forearm
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
Remove waste products Assist venous return Effective in decreasing
hypertonicity Beneficial in mechanically
softening the superficial fascia
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
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 mostimportant massage technique
Generally performed for 30seconds to 10 minutes
No lubricant used
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
Cross-fiber technique Storm’s technique Cyriax’s friction massage
Aka percussion massage The skin and muscle are
impacted with repetitive compressive blows by the hands
Used when stimulation is desired Usually performed in athletes Can be done to prepare patient
for stretching Used to loosen mucus in the
lungs
Hacking Cupping Fist beating Beating over palm Slapping Finger tapping
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
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
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)
Can be used to replace effleurage if gliding strokes can not be performed
Used to tone the musclesStimulates the muscle spindle
Relaxes muscle groups or an entire limb
Warms and prepares the body for deeper bodywork
Indicated for extremely tight muscles
Soothing and rhythmic method used to calm an individual
Up-and-down and side-to-die movement of the body
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
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.
Shi (finger) and atsu (pressure
Japanese form of acupuncture
Pressure is applied at specific points (meridians)
Was first administered by blind clinicians
Milieu Treatment variables
Friction-reducing mediumRhythmRatePressureDirectionArea to be treatedDurationFrequencyDuration of the program
Fascia: three-dimensional web of connective tissue running continuously through the body and superficial to deep without any interruption
Three layers:SuperficialDeepDural
Functions of Fascia:Holds tissues togetherSeparates structures to allow mobility
Protection, nutrition, elimination, and metabolism
Composition:CollagenElastinGround substance
Fascial RestrictionsCause 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
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
A whole-body “hands-on” approach to evaluation and treatment of the human structureEvaluation of fascial systemInterventionRe-evaluation
Incorporated in a comprehensive program that includes modalities, therapeutic exercise, muscle energy techniques, mobilization and manipulation
Pain Movement restrictions Spasm Neurologic dysfunction Sports injuries Chronic fatigue syndrome Fibromyalgia Pediatrics Scoliosis Menstrual, pelvic,
temporomandibular pain Headache
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
Cross-hand techniques Arm or leg pull (unilateral or bilateral) Cranial base release Skin rolling Scar release J-stroke
Any questions?
Brault, J. S., Kappler, R. E., Grogg, B. E. (2007). Manipulaiton, traction, and massage. In Braddom, R. L. (Ed) Physical medicine & rehabilitation. Philadelphia: Elsevier Inc.
Cantu, R. I., Grodin, A. J. (1992). Myofascial manipulation: Theory and clinical application. Maryland: Aspen Publishers, Inc.
de las Peñas, C.F., Campo, M.S., Carnero J.F. & Page, J.C.M. (2005). Manual therapies in myofascial trigger point treatment: a systematic review. Journal of Bodywork and Movement Therapies. Retrieved July 28, 2008 from http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WHF-4D97YT8-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1a86d354ca36e2b5c7e9e62aed07dc37.
Fritz, S. (2000). Fundamentals of therapeutic massage (2nd ed). USA: Mosby-yearbook, Inc.Gomez, M. Z. A. (2008). Lecture notes on massage and myofascial mobilization. UP- Manila
College of Allied Medical Professions.Rechtien, J. J., Andary, M., Holmes, T., and Wieting, J. M. (1998). Manipulation, massage, and
traction. In De Lisa, J., and Gans, B. Rehabilitation medicine: Principles and practice (Eds). Philadelphia: Lippincott-Raven Publishers.
Rickards, L.D. (2007). The effectiveness of non-invasive treatments for active myofascial trigger point pain: A systematic review of the literature. International Journal of Osteopathic Medicine. Retrieved July 28, 2008 http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7RM5-4MK0N7B1&_coverDate=12%2F31%2F2006&_alid=522228570&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=25741&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4f44892772cc6bbc024dc953f16bdffb.
Tappan, F. (1988). Healing massage techniques: Holistic, classic, and emerging methods (2nd ed). Connecticut: Appleton & Lange.
