Therapeutic MassageTherapeutic Massage

Chapter 16Chapter 16

Historical PerspectiveHistorical Perspective

Dating back to the ancient Dating back to the ancient OlympiansOlympians

Late 1980’s Late 1980’s – American Massage Therapy American Massage Therapy

1992 1992 – National Certification Examination for National Certification Examination for

Therapeutic Massage and Bodywork Therapeutic Massage and Bodywork

PurposePurpose Manipulates the the body’s tissues Manipulates the the body’s tissues

to:to:– Reduce muscle spasmReduce muscle spasm– Promote relaxationPromote relaxation– Improve blood flowImprove blood flow– Increase venous drainageIncrease venous drainage

Broad range of massage theories, Broad range of massage theories, techniques, and effectstechniques, and effects

Basic Massage Basic Massage StrokesStrokes

EffleurageEffleurage PétrissagePétrissage FrictionFriction TapotementTapotement VibrationVibration

Myofascial ReleaseMyofascial Release J-StrokesJ-Strokes Focused StretchingFocused Stretching Skin RollingSkin Rolling Arm Pull / Leg PullArm Pull / Leg Pull Diagonal ReleaseDiagonal Release

Types of MassageTypes of Massage

EffleurageEffleurage ““Stroking of the skin”Stroking of the skin” Spread massage lubricantSpread massage lubricant Use at the beginning and Use at the beginning and

end of the massageend of the massage Superficial: Superficial:

– slow strokes for relaxationslow strokes for relaxation Deep: Deep:

– Elongates muscle fibersElongates muscle fibers– Stretches fasciaStretches fascia– Forces fluids in the direction of Forces fluids in the direction of

the strokethe stroke towards the hearttowards the heart

PétrissagePétrissage ““Lifting and Lifting and

kneading”kneading” Frees adhesions:Frees adhesions:

– Stretches and Stretches and separates muscle separates muscle fiber, fascia, and scar fiber, fascia, and scar tissuetissue

If only technique If only technique used, it may be used, it may be performed without performed without the use of lubricantthe use of lubricant

FrictionFriction

““Deep pressure”Deep pressure” Effects muscle mobilization, tissue Effects muscle mobilization, tissue

separation, and trigger pointsseparation, and trigger points Two types:Two types:

– CircularCircular– TransverseTransverse

Circular Friction MassageCircular Friction Massage

Use a circular Use a circular motionmotion– ThumbsThumbs– ElbowElbow– Commercial deviceCommercial device

Transverse Friction MassageTransverse Friction Massage Strokes perpendicular Strokes perpendicular

to tissue fibersto tissue fibers The thumbs or The thumbs or

fingertips stroke in fingertips stroke in opposite directionsopposite directions

TapotementTapotement

““Tapping or pounding” of the skinTapping or pounding” of the skin Variations:Variations:

– HackingHacking– CuppingCupping– Pincement (pinching)Pincement (pinching)– RappingRapping– TappingTapping

Tapotement TechniqueTapotement Technique

Performed with a Performed with a light, fast tempolight, fast tempo

Promotes muscular Promotes muscular and systemic and systemic relaxation and relaxation and desensitization of desensitization of irritated nerve irritated nerve endingsendings

VibrationVibration

““Rapid Shaking”Rapid Shaking” Increases blood flow and provides Increases blood flow and provides

systemic invigoration of tissuessystemic invigoration of tissues Mechanical devices availableMechanical devices available

Myofascial ReleaseMyofascial Release Stroking and stretching of tissues:Stroking and stretching of tissues:

– Relax tense tissuesRelax tense tissues– Release adhered tissuesRelease adhered tissues– Restore tissue mobilityRestore tissue mobility

Clinician receives cues and feedback from Clinician receives cues and feedback from the patient’s tissue the patient’s tissue – This indicates the appropriate strokes and This indicates the appropriate strokes and

stretches stretches Specialized training in myofascial release Specialized training in myofascial release

techniques is needed to become proficient techniques is needed to become proficient in these skillsin these skills

J-StrokesJ-Strokes

One hand places the One hand places the adhesion on stretchadhesion on stretch

Other hand’s 2Other hand’s 2ndnd and 3 and 3rdrd fingers stroke in the fingers stroke in the opposite direction opposite direction forming a ‘J’forming a ‘J’

Mobilize scar tissueMobilize scar tissue

Focused StretchingFocused Stretching Heel of one hand in the area of restrictionHeel of one hand in the area of restriction Heel of other hand crossed in frontHeel of other hand crossed in front Stretch the tissue using slow, deep pressureStretch the tissue using slow, deep pressure Reduces superficial or Reduces superficial or

deep adhesionsdeep adhesions

Skin RollingSkin Rolling Use fingers and thumb to Use fingers and thumb to

lift and separate the skin lift and separate the skin from the underlying tissuefrom the underlying tissue– Similar to PétrissageSimilar to Pétrissage

Roll skin between fingers Roll skin between fingers noting restrictionnoting restriction

Lift skin and move it in the Lift skin and move it in the direction of the restrictiondirection of the restriction

Reduces superficial Reduces superficial myofascial adhesionsmyofascial adhesions

Arm Pull/Leg PullArm Pull/Leg Pull

Arm pull (example):Arm pull (example): Grasp extremity proximal Grasp extremity proximal

to wristto wrist Apply gentle traction that Apply gentle traction that

is in line with anterior is in line with anterior deltoiddeltoid

Continue to abduct 10-15 Continue to abduct 10-15 degrees until full degrees until full abduction is reachedabduction is reached

Stretches large areas of Stretches large areas of fascia fascia

Diagonal ReleaseDiagonal Release

One clinician grasps the leg proximal to One clinician grasps the leg proximal to talocrural jointtalocrural joint

Other grasps the opposite arm proximal Other grasps the opposite arm proximal to wristto wrist

Keep extremities horizontal to each otherKeep extremities horizontal to each other One moves the limb until adhesions are One moves the limb until adhesions are

felt while the other stabilizes the felt while the other stabilizes the extremityextremity

Stretch large area of fasciaStretch large area of fascia

Physiological EffectsPhysiological Effects CardiovascularCardiovascular

– Increase blood flow, histamine release, and temperatureIncrease blood flow, histamine release, and temperature– Decreased heart rate, respiratory rate, and blood Decreased heart rate, respiratory rate, and blood

pressurepressure NeuromuscularNeuromuscular

– Increase flexibility, decrease neuromuscular excitability Increase flexibility, decrease neuromuscular excitability (relaxation), edema reduction, and stretch muscle and (relaxation), edema reduction, and stretch muscle and scar tissuescar tissue

PainPain– Activate spinal gate and the release of endogenous Activate spinal gate and the release of endogenous

opiatesopiates PsychologicalPsychological

– Reduces patient anxiety, depression, and mental stressReduces patient anxiety, depression, and mental stress

IndicationsIndications

Increase blood flowIncrease blood flow Facilitate healingFacilitate healing Increase range of motionIncrease range of motion Remove edemaRemove edema Alleviate muscle crampsAlleviate muscle cramps Stretch scar tissue/adhesionsStretch scar tissue/adhesions Decrease painDecrease pain

ContraindicationsContraindications

Acute inflammatory conditionsAcute inflammatory conditions Severe varicose veinsSevere varicose veins Open woundsOpen wounds Skin infectionsSkin infections Failed or incomplete fracture healingFailed or incomplete fracture healing ThrombophlebitisThrombophlebitis

PreparationPreparation

TableTable Linens and pillowsLinens and pillows Massage lubricantMassage lubricant Patient positionPatient position Masseuse positionMasseuse position

Traditional MassageTraditional Massage

Apply massage medium Apply massage medium with light, slowwith light, slow

Build to deeper effleurageBuild to deeper effleurage PétrissagePétrissage Wipe medium before Wipe medium before

applying deep friction (if applying deep friction (if applicable)applicable)

Reapply pétrissage and Reapply pétrissage and deep effleuragedeep effleurage

End with light effleurageEnd with light effleurage

Edema Reduction Edema Reduction MassageMassage

PreparationPreparation

Elevate the body areaElevate the body area Apply massage lubricant to the skinApply massage lubricant to the skin Clinician is positioned distal to the Clinician is positioned distal to the

extremityextremity

Stroke SequenceStroke Sequence Begin proximal to the Begin proximal to the

edematous areaedematous area Long, slow, deep Long, slow, deep

strokes towards the strokes towards the torsotorso

Move starting point Move starting point slightly distal every slightly distal every fourth or fifth strokefourth or fifth stroke

When the starting When the starting point moves distal to point moves distal to the edema, begin the edema, begin working back towards working back towards the starting pointthe starting point

TerminationTermination

Remove mediumRemove medium If appropriate:If appropriate:

– Active range of motion exercisesActive range of motion exercises– Compression wrapCompression wrap

Encourage patient to drink water to Encourage patient to drink water to assist in flushing metabolic wasteassist in flushing metabolic waste