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.