Therapeutic Massage techniques

By: Leila Angooti ; Msc of OT, Lymph therapistOccupational Therapy Unit, Physical Medicine Rehabilitation Department

Cancer Research Center, Shahid Beheshti University

Massage

History & Introduction of Massage Therapy:

یونانی به معنای دستMassineلغت ماساژ از •

ون و خحرکات منظم روی بافت نرم برای تاثیر در سیستم عصبی، عضلانی، پوست، گردش •، حتی مفاصللنف

مصری ها، ایرانیها، یونانیان، چینی ها و ژاپنی ها پیشرو•

عوارض درمان برخیناتوانان و برای بازگرداندن نیروی عضلانی بقراط و ابوعلی سینا تاکید •عضلانی -مفصلی

13در قرن فردریک دوم آزمایش امپراتورآلمان، •

Some Massage Modalities:

Swedish massage (Mennel):

• Stroking /effleurage• Superficial stroking

• Deep stroking

• Effleurage / Retrograde

• Knuckling / Thousand hand

• Compression /kneading/ petrissage• Circular kneading

• Picking up

• Wringing

• Rolling

• Friction: transverse, circular

• Percussion• Taptoment: Hacking, Clapping, cupping, Slapping, Tapping, Beating, Pounding, Pinchment

• Vibration : Vibration & Shaking

Infant Massage

Manual lymphatic drainage (MLD)

• Stationary Technique: with C-shaped movement

• Rotary T.: with deviation of wrist

• Scooping T.: with palms of hands

• Pumping T.: with web

Cranial/Sacral

بهبود سلامتی و انرژی،...(پروتئین، اسید آمینه، الکترولیت و )رفع انسداد حرکت مایع سینوویال

کاهش استرس و سردرد و رگیجه و وزوز گوش، بهبود خواب، عملکرد ارگان های بدن

Aromatherapy

روش های استنشاقی، ماساژ پوستی، حمام

، یاسمن رزگلترنج، بابونه ی معطر، بهار نارنج، گل مریم، : استرسکاهش

نارنجمرزنجوش، بهار : بی قراری و بی خوابیرفع

حناکاج، درخت ، بابونه ی معطر، آویشنروغن اسطوخودوس، لیمو، ترنج، : دفاع بدنافزایش

دشتی، گربه رزماری: مفصلیرفع خشکی

Shiatsu (Japanese massage)

KI- CHI- PRANA

Yang & yin

Five elements

Hara –Tanden-Meimon

Canals- meridian -kings

Teshubu365

Techniques

• Pressures (palming-fingers-thumbs-elbow-knee-foots-body)

• Stretching

• rotation

Acupressure

LI 4: large intestine channel: dorsal thumb web of hand ( :میگرن، فک، دندان)خستگی، دردها کاهش

LIV 3: liver C. lat. thumb MP of foot: ادراری تهوع، درد تناسلی، مشکلات ، مفصل و کاهش سردرد شدید، درد قاعدگیتغذیه

SP 6: Spleen C: 4 Finger above med. Ankle: کاهش درد شکمی و قاعدگی

GB 34: gall bladder C.: below lat. Knee: مفصلی عملکرد کبد و کاهش اسپاسم عضلانی، کرامپ شکم، زردی، درد بهبود

St 36: stomach C.: below ant. Knee: انرژی بدنافزایش

Reflexology (zone therapy)

3و2وMP1بالای کف انگشتان و کف : بازتاب در مغز و گردن

خط داخلی کف پا، لبه خارجی از شست دست تا مچ: بازتاب در ستون فقرات

Polarity

و آزادی انرژی–و + قطب از دو دست برای ماساژ مثل

Mayan Abdominal Massage

داخلیارگانهایماساژ

Structural Integration

و حفظ تعادل myofascial release استفاده از

Segmental

هاپاراورتبرال ماساژ روی

Neuromuscular therapy

ثابتفشاربا

Touch for health

و افزایش عملکرد با لمسکاهش استرس و درد تعادل پوسچر،

Pre/perinatal

بارداریماساژ

Sports Massage

عمقی با فشارهای

Russian

با فشار متوسط و زیاد ریلکسی جزو ماساژهای

Lomi Lomi (Hawaiian)

شبیه رقص و حرکاتروغن معطر شروع با دعا و

Feldenkrais

اندامهاحركت غلط وضعیت بدن و دادن آگاهی از الگوهای

Jin Shin Jyutsu (Physio-Philosophy)

سوزنيانگشتان یا كف دست روي نقاط طب فشار یا ضربه

Reiki

هالهاسکن کردن، جارو کردن، انرژی دادن

Pediatric massage

Growth of children (physical-motor-cognitive-emotional-social development) & adapting massage:

1. The first 3 years: repetitive movement- enjoy novel- fear separation

• infant M. starts from legs- 10-15 min

2. Preschoolers (3-6): breath with diaphragm- gross & fine motor-visual skills- left/right- fear of injury- dress up

• Pediatric M. needs Extra patience – playfulness - distraction with singing & telling story - by mother - end up when screaming - more familiar with environment - using their favorite toys & music & animals - asking for dressing - observe their nonverbal cues - back M may suddenly become stomach M - explain-hazardous items out of reach - 30 min

3. School-age (6-12): athletic activity- fine skills- posture-lateralization- comparison- independent start- same sex friends-right/wrong- headache/stomachache/insomnia/loss of appetite

• After school - feel comfortable - remain clothed - understand benefits of massage - right pressure - not overstretch- 30 min

4. Teenager (12-18): begin like adults- strength- coordination-stamina- confidence- memory- attention- abstract thinking-problem solving- sense of relationship- appropriate decisions-personal responsibility- adjust to changing body

• Allow to watch your office a session with a parent or friend -explain plan - may feel uncomfortable with therapist or opposite sex - clothed/uncover only area - teach a simple relax. Sequence -not painful - speaking about their body - motivated to heal by sport- 60 min

Benefits of Pediatric massage:

•Physiologic benefits

•Emotional effects

•Perceptual feedback

1. Physiologic benefits of M. in children:

• Prevent chronic muscloskeletal problems (body alignments & trigger points factors)

• Relaxes muscles (flexibility in CP)

• Stretches connective tissue (skin, muscle, fascia, scar)

• Increases venous blood & lymph (5 min Swedish M. increases heart pump) & cerebrospinal flow & deeper breathing (expansion in cystic fibrosis) & immunefunction

• Reduces heart rate & blood pressure & anxiety & depression & insomnia &pain (mobilization in RSD) & (combination massages in headache)

• Changes production of hormones (Effleurage M. decrease cortisol & norepinephrine in burns, infants, asthma, bulimia, JRA, PTSD, psychiatrics & glucose in diabetics)

• Sensory stimulation (cortical brain growth by age of 7 in lack normal experiences due to increasing 25% synapses per neuron)

2. Emotional effects of M. in children:

1. Reduces psychological distress & effects of stressors (modern life, media

pressure, deterioration of family, child maltreatment & physical abuse, loss of

religious beliefs, competition instead of play, inadequate child care, poverty) &

behavioral effects of stress (dropout, crime, substance abuse, depression,

suicide, sexual A, eating D, type A behavior, psychosomatic D) & Long term

effects of trauma & pain (fear, TP, perception & reaction to pain)

2. Reduces Stress- related health problems:

• Cardiovascular S.: migraine headaches, HT

• Gastrointestinal S.: colitis, diarrhea, vomiting, encopresis, abdominal pain, obesity,

anorexia nervosa

• Respiratory S.: asthma, coughing

• Urinary S.: bedwetting, urinary frequency

• Neuromuscular S.: muscle contraction headaches, tics

• CNS: epileptic seizures

• Skin problems: warts, habitual scratching, anxiety-produced hives

• Conversion reactions: hysterical motor like paralysis, blindness, back pain, dizziness,

hallucinations

3. Bodily physiologically & behaviorally response to stress (fight-or-flight & react in various ways) in:

Adrenal glands: Cortisol H (anti inflammation by suppress immune system.) (but increasing it causes weakness, memory D, attention D, anxiety, emotional outbursts)

Thyroid gland: Thyroxin H (metabolism of body that increasing it causes shaky nerves, insomnia, exhaustion)

Brain: Endorphin H (pain killer that decreasing it causes tolerance reduce)

Digestive tract: movements (stopping it causes to stop blood diverting to muscles, cramps, nausea, bloating, diarrhea)

Stomach: hydrochloric acid. (but decreasing it causes pain)

Pancreas: insulin. (but decreasing it causes diabetics)

Liver: cholesterol (increasing it causes arteriosclerosis in blood vessels)

Heart: beats harder & faster (increasing it causes heart D & stroke)

5 senses: become more acute (continuing it causes burn out & concentration D)

Muscle: tension (increasing it causes pain, stiffness)

3. Perceptual feedback of M. in children:

• Healthy body image leads to (central sense of self) that develops during infancy & shapes in childhood & teenage (concerning about self) for:

• Perceive themselves & others

• Interact well with environment

• Good balance

• Good spatial orientation

• Good Dexterity (not clumsy)

• Causes of Damaging body image:• Physical abuse

• Touch deprivation

• Neurologic problems

• Stress & strife (rigid personality that attracted to thrill-seeking behaviors, alcohol & drug abuse to intensify their sensations)

How does massage work in pain?

1. Gate Theory (fast nervous fibers (like A) from fine & moving on skin sense goes faster through internal lemniscal than slow nervous fibers (like C) from pain through spinothalamic way to CNS & closes gate control).

2. Stimulates the release of endorphins from brain.

3. Increases circulation in muscle fibers, soft tissues.• Blood brings nutrients and eliminates waste

• Blood can’t enter the cells that are adhered to each other = waste build up

blood to enter and flow through the muscle cells

Muscle & fascia

Muscle structure & contraction:

Length of nerves: 11 inchesShorten muscle: 40% of its lengthEach fiber has: 1 neuronSource of energy in fiber (ATP): Metabolism of glycogenExhaustion due to: decrease ATP

Muscle architecture (formation of fibers):

Fascia(connective tissue in all body, prop. Sense, collagen, elastin, fiber):

• Superficial (under skin): contain fat, fascicles, vessels, nerves• Collagen follows Langer΄s lines

• Deep (enclose muscles, aponeurosis (is like tendon)): for pain free movement

Trigger/ Tender:

• Tender point/strain-counterstrain/positional release: • tenderness such as bruising, injury, lack of MG…

• Trigger point: pain with a taut band due to over use of muscle or poor position, repetitive motion, sudden excessive stretch

• Active: referred pain

• Latent: pain with pressure

• Primary: pain by muscle stress

• Satellite: secondarily by primary

Causes of myofascial TP in children:

•Position of fetus

•Intrauterine crowding

•Birth trauma

•Infection & injuries

Massage in Trigger points (×) & pain patterns ( ) that cause bad posture:in children by trauma, muscle contraction, poor posture

Facial treatment:in treating muscle, you are treating fascia

• Skin rolling: rolling sup. fascia & muscle with thumbs & fingertips, across fibers

• Myofascial release/ cross hand: stretch length of muscle fibers & deep fascia with 2 palm hands to break inter fibers connection, across

• Bindegewebmassage/directive fascial work: compress+ Stretch+ compress+ active resistance, across

• Rolfing/ Hellerwork/ Core myofascial therapy: working along Langers lines to reorientation

• Neuromuscular therapy: with thumbs, along or across fibers

Assessment alignment before massage:

Indication of massage:

• Allergies • Anxiety• Arthritis (both osteoarthritis and rheumatoid arthritis)• Asthma and bronchitis• Carpal tunnel syndrome• Chronic and acute pain• Circulatory problems• Depression• Digestive disorders, including spastic colon, constipation and diarrhea• Gastrointestinal disorders

• Tension-related Headache & eye-strain

• Immune function disorders• Insomnia • Myofascial pain (a condition of the tissue connecting the muscles)• Premature infants• Reduced range of motion• Sinusitis• Sports injuries (including pulled or strained muscles and sprained ligaments)• Stress• Tempomandibular joint (TMJ) dysfunction

Preventing boundary violations with parents:• Don’t judge parents

• May you must counsel with practitioner of child

• Be sure from relating disorder of parents & lack of touch in children

Condition of pediatric massage:

Preventing boundary violations with children:• Preventing young children to turn on table by prone position & look at books/

speaking with their parents/ explaining for older children/ permitting

• Their diapers change before M

• Check temperature of room

• Oil test if it needs

• Comfortable dressing & exercise of therapist & short nails & clean – warmhands

• Standing on head or one side of child

• Supine

• Prone

• Sitting

Child’s position

Contraindications of massage in children:

• Skin disorders (sores- cuts- burns- boils- rashes)

• Inflamed joints

• Tumors/ undiagnosed lumps

• Injuries (bruises- joint sprains- Fx- Dx)

• Endangerment sites (back of knee- xiphoid process- inner elbow)

• Fever

Basic of Swedish (stroke) massage:

• light touch/ nurturing touch

• Stroking /effleurage:• Superficial stroking / moving light touch: may Hair direct (1 in 5 s)

• Warming glide: trunk, dist to prox

• Soothing glide: trunk, prox to dist

• Deep stroking: dist. To prox.• Stripping: along muscle with spasm

• Straight pushing: forearm- finger

• Pushing apart: clavicle

• Retrograde: in elevation if edema• low, high, low

• same, high

• Thousand hand/ knuckling: with IP ext., MP flex.

• Kneading / petrissage: palmar or thumb kneading, alternative hands• Circular kneading: Varying pressure

• Picking up: V, C• One- handed

• Praying hand: clasp hand

• Alternative hand: with two- hand

• Fulling: inter bones

• Wringing k: bow tie

• Rolling k: (pinching & pulling)2 kinds of fingers movements

• two- handed Ocean waves: parallel across of trunk

• Open heart: with thumbs or fingertips

• Raking: like cat, prox. To dist. limbs

• Thumb stroking: 2.5-15 cm

• Criss- cross: hands in opposite sides

• Compression:• Heel of hand: Thenar & hypothenar for compression• Fist / handful• Knuckles: distal phalanxes but not for face, neck, ribs• Thumb (s)/ fingertips (pressing or acupressure): deep points

of face, neck, axilla, abdomen, groin• Elbow: for extra force• Forearm (ulnar side)

• Nipping: with nail

• Friction• Circular F.

• Stable

• Mobile: with same pressure

• Transverse/ rubbing• Superficial warming

• Sawing: in med, board of scapula

• Deep transverse• Cross-fiber: in TP

• web stroking with thumb= chucking: for webs

• Rolling f: stroke from med. & lat. Limb with ext. palms

• Wringing f: stroke from sup. & inf. Limb with flex. palms

• Percussion/ Taptoment• Taptoment

• Tapping• Tapping punctuation• Tapping pulsing• Tapping rain drop: like playing piano

• Hacking• Quacking: ext. palm to ext. palm• Clapping: quick stroke dorsal fingers of feet• cupping• Slapping• Beating• Rapping: fist down• Pounding• Pincement: like picking coin• Diffused: tape on other hand of therapist, belly

• Vibration• vibration

• Fine: with finertips• Jostling: like RIP• Coarse: shake lower extremity with web/ palm• Rocking: trunk swing

• shaking

References:

• Clay JH, Pounds DM. Basic clinical massage therapy. Integrating anatomy & treatment. LWW massage therapy & bodywork educational series. Second ed. 2008.

• Lowe WW, orthopedic massage. Theory & technique. 2003.

• Sinclair, M. Pediatric massage therapy. LWW in touch series. 2005.

• Holly E, Cook E. Therapeutic massage. 2017.

• Lundberg, Paul. The book of shiatsu. 1992.

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