therapeutic sports massage

© 2009 McGraw-Hill Higher Education. All rights reserved.

Chapter 13: Massage


Physiologic Effects of Massage

• Mechanical stimulation of tissues by rhythmically applied pressure and stretching– Often used to increase flexibility and

coordination, decrease pain & neuromuscular excitability, stimulate circulation and facilitate healing

• Effects of massage may be either reflexive or mechanical


Physiologic Effects of Massage

• Reflexive – Effects sensory and motor nerves locally

and some central nervous system response

• Mechanical– Makes mechanical or histological

changes in myofascial structures through direct force applied superficially


Reflexive Effects

• Attempts to exert effects through skin and superficial connective tissues

• Contact stimulates cutaneous receptors – Reflex mechanism is believed to be an

autonomic nervous system phenomenon • The reflex stimulus causes sedation,

relieves tension, increases blood flow


Reflexive Effects• Effects on pain

– Modulates pain through gate control & -endorphins

• Effects on Circulation– Increase blood flow

• Light touch causes transient dilation of lymphatics and small capillaries

• Results in increased temperature in area– Increased lymphatic flow

• Assists in removal of edema– May also impact lactate clearance


• Effects on MetabolismEffects on Metabolism– Does not alter general metabolism Does not alter general metabolism – No alterations in acid-base No alterations in acid-base

equilibrium of bloodequilibrium of blood– No significant effects on No significant effects on

cardiovascular systemcardiovascular system– Assists in removal and hastens Assists in removal and hastens

resynthesis of lactic acid resynthesis of lactic acid


Mechanical Effects• Techniques which stretch a muscle, elongate

fascia or mobilize soft tissue adhesions or restrictions

• Always accompanied by some reflex effects – As mechanical stimulus becomes more effective,

reflex stimulus becomes less effective

• Directed at deeper tissues, such as adhesions or restrictions in muscle, tendons, and fascia.


Mechanical Effects• Effects on muscle

– Mechanical stretching of intramuscular connective tissue

– To relieve pain and discomfort associated with myofascial trigger points

– Increase blood flow to skeletal muscle – To retard muscle atrophy following injury– To increase range of motion – Does not increase strength or muscle tone


Mechanical Effects• Effects on skin

– Increase in skin temperature– Increases sweating – Mechanically loosens adhesions and

softens scar – Stretches and breaks down fibrous scar

tissue – Breaks down adhesions between skin and

subcutaneous tissue


Psychological Effects of Massage

• Psychological effects of massage can be as beneficial as physiologic effects

• “Hands on” effect helps patients feel as if someone is helping them

• Lowers psycho-emotional and somatic arousal – Tension & anxiety


Treatment Considerations and Guidelines

• Knowledge of anatomy essential • Understanding of existing

pathology • Thorough knowledge of massage

principles


Positioning of Clinician• Positioning will allow

relaxation, prevent fatigue, and permit free movement of arms, hands, and body

• Weight evenly distributed and should shift from one

foot to the other • Fit your hands to contour

of area being treated• Hands should be warm


Treatment Techniques Pressure regulation determined by the type and

amount of tissue present and patient's condition Rhythm must be steady and even Duration depends on the pathology, size of the

area being treated, speed of motion, age, size, and condition

With swelling begin proximally to facilitate lymphatic flow -"uncorking effect"


Massage should never be painful Direction of forces should parallel muscle fibers Begin and end with effleurage Make sure patient is warm and in a

comfortable, relaxed position Body part may be elevated if necessary Sufficient lubricant should be used Begin with superficial stroking to spread

lubricant


Stroke should overlap Pressure should be in

line with venous flow followed by a return stroke

All strokes should be rhythmic


Equipment Set Up• Table• Linens and pillows• Lubricant

– Should be absorbed slightly by skin but does not make it slippery

• Combination of one part beeswax to three parts coconut oil

– Other types of lubricants that may be used are olive oil, mineral oil, cocoa butter, hydrolanolin, analgesic creams, alcohol, powder


Preparation of Patient

• Patient should be in a relaxed, comfortable position

• Part involved in treatment must be adequately supported

• Prone, supine, seated• Clothing should be

removed from part being treated


Massage Treatment Massage Treatment TechniquesTechniques


Hoffa Massage

• Classical massage technique which uses a variety of superficial strokes– Effleurage – Petrissage – Tapotement – Vibration


Effleurage (Stroking)

• Every massage begins and ends with effleurage

• Increases venous and lymphatic flow

• Increases circulation to skin surface

• Start with a light pressure, move centripetally or centrifugally consistently throughout treatment


Effleurage (Stroking)

• Deep stroking is a form of effleurage, except it is given with more pressure to produce a mechanical effect

• Kneading stroke is directed towards the heart


Petrissage(Kneading)

• Consists of kneading manipulations that press and roll muscles under fingers or hands

• Muscles are gently squeezed, lifted, and relaxed

• Hands may remain stationary or move along length of muscle or limb


Petrissage(Kneading)

• Purpose is to increase venous and lymphatic return and to press metabolic waste products out of affected areas through intensive vigorous action

• Can also break up adhesions between skin and underlying tissue


Tapotment(Percussion)

• Uses a variety of percussive or beating techniques

• Brisk blows administered with relaxed hands (rapid alternating movement

• Used to increase circulation and blood flow

• Used to stimulate peripheral nerve endings



• Hacking



• Hacking• Slapping



• Hacking• Slapping• Beating



• Hacking• Slapping• Beating• Tapping



• Hacking• Slapping• Beating• Tapping • Clapping or cupping


Vibration• A fine tremulous

movement, made by hand or fingers placed firmly against a part causing a part to vibrate

• Hands should remain in contact and a rhythmical trembling movement will come from arms


Friction Massage

• Purpose: – Loosen adherent fibrous

tissue (scar) – Aid in edema absorption– Reduce muscle spasm– Produce reflex effects

• Involves small circular movements directed at underlying structures beneath superficial tissues


Transverse Friction Massage

• Technique for treating chronic tendon inflammation

• Purpose is to increase inflammatory response to progress healing process

• Use strong pressure in perpendicular direction to fibers for 7 to 10 minutes every other day


Connective Tissue Massage(Bindegewebsmassage)

• Stroking technique carried out in layers of connective tissue on body surface

• Abnormal tension in one part of tissue is reflected in other parts

• Stroking produces a relaxation of muscular tension and a prickling warmth in area

• Used mostly in Europe



• Patient is usually in sitting position • Basic stroke of pulling performed with

tips, or pads, of the middle and ring fingers of either hand

• Stroking technique characterized by a tangential pull on skin and subcutaneous tissues away from fascia

• Technique causes sharp pain in tissue



• No lubricant is used• Treatments last about 15 to 25 minutes

After 15 treatments 2-3 times per week, there should be a rest period of 4 weeks

• Connective tissue massage must be learned and performed initially under direct supervision of someone who has been taught these highly specialized techniques


• IndicationsIndications– Scars on the skinScars on the skin– Fractures and arthritis in bones and jointsFractures and arthritis in bones and joints– Low back painLow back pain– Varicose symptoms, thrombophlebitis, hemorrhoids, edema Varicose symptoms, thrombophlebitis, hemorrhoids, edema

in blood and lymphin blood and lymph– Raynaud’s disease, intermittent claudication, frostbiteRaynaud’s disease, intermittent claudication, frostbite– Myocardial dysfunctions, respiratory disturbancesMyocardial dysfunctions, respiratory disturbances– Intestinal disorders, ulcers, hepatitis, amenorrhea, Intestinal disorders, ulcers, hepatitis, amenorrhea,

dysmenorrhea, genital infantilism, Parkinson’s disease, dysmenorrhea, genital infantilism, Parkinson’s disease, migrainesmigraines


Trigger Point Massage

• Myofascial trigger points found in skeletal muscle and tendons, in myofascia, in ligaments and capsules surrounding joints, in periosteum, in skin

• May be activated and become painful due to some trauma to muscle occurring either from direct trauma or from overuse


• Pain results from inflammatory response

• Pain usually referred to areas which follow a specific pattern

• Stimulation of these points has been demonstrated to result in pain relief

• Acupressure points and myofascial trigger points are similar


• Latent trigger pointsLatent trigger points– Don’t cause spontaneous pain, may restrict movementDon’t cause spontaneous pain, may restrict movement

• Active trigger pointsActive trigger points– Causes pain at restCauses pain at rest– Tender to palpation with referred painTender to palpation with referred pain– Identification:Identification:

• Patient has persistent regional pain resulting in decreased ROMPatient has persistent regional pain resulting in decreased ROM• Hypersensitive nodules Hypersensitive nodules palpation results in pain in the area palpation results in pain in the area

and radiation of painand radiation of pain• Contracting involved muscle Contracting involved muscle increases pain increases pain• Firm pressure usually elicits “jump sign”Firm pressure usually elicits “jump sign”


• Acupressure and trigger point massage Acupressure and trigger point massage are very similarare very similar– Independently discovered but rely on similar Independently discovered but rely on similar

underlying neural mechanismsunderlying neural mechanisms

• Treatment effectiveness may be result of Treatment effectiveness may be result of intense, low-frequency stimulation of intense, low-frequency stimulation of trigger points and release of trigger points and release of -endorphins-endorphins


Trigger Point Massage Techniques

• Locate points from chart • Use fingers or elbow to do small friction-

like circular motions • Amount of pressure applied should be

intense and painful • Patient reports a dulling or numbing effect • Treatment times range from 1-5 min at

several points


Strain-Counterstrain• Approach used to decrease muscle tension • Passive technique that places body in

position of greatest comfort pain relief• Athletic trainer locates a trigger point

corresponding to point of dysfunction– Tend to be located deep in tendons, fascia &

muscles– Tense, tender, edematous spots


• Clinician monitors tension and pain of tender point while patient is moved into position of comfort– Often involves shortening of muscle/tissue– Tender spot will no longer be painful in this position

• After 90 seconds pain and point should be cleared or reduced

• Patient is then returned to resting position and should note change in symptoms associated with trigger point


Strain-Counterstrain

• Physiological rationale– Stretch reflex– Muscle is placed on slack, reducing

muscle spindle input– Facilitates relaxation and hence

decrease tension and pain


Positional Release Therapy

• Based on strain-counterstrain – Difference is the use of a facilitating force

• Follows the same steps as strain-counterstrain

• Incorporates maintained compression on tender point– Suggested that maintaining contact

exerts a therapeutic effect


Active Release Therapy• Used to correct soft-tissue problems in muscle,

tendons & fascia – Fibrotic adhesions due to acute injury, pressure/tension

injuries, repetitive overuse injuries• Deep tissue technique

– Clinician identifies the area and traps the affected muscle by applying pressure

– Patient then actively elongates the muscle – Repeated 3-5 times– Patient must follow stretching, activity modification and

exercise instructions


Active Release Therapy


Myofascial Release

• Has also been referred to as soft tissue mobilization

• Group of stretching techniques used to relieve soft tissue from abnormal grip of tight fascia

• Myofascial restrictions are unpredictable and may occur in many different planes and directions


Myofascial Release

• Treatment is on localizing restriction and moving into the direction of the restriction

• Soft tissue mobilization technique• Myofascial manipulation relies

heavily on experience of clinician


• Focuses on large treatment areas– Can have significant impact on joint mobility– Massage occurs through the restriction

• With improvements in extensibility of tissue, stretching should be incorporated– Strengthening is also recommended to enhance

neuromuscular re-education– Postural re-education may help ensure maintenance of

less restricted movement patterns• Acute cases tend to resolve after a few treatments;

while longer conditions require additional treatment


Myofascial Release Technique

• Preparing clinician’s hands

• Use limited lubricant

• Positioning critical to maximize effects of treatment


Graston Technique• Instrument-assisted soft

tissue mobilization used to breakdown scar tissue and fascial restrictions

• Uses handheld stainless steel instruments to scan, locate and treat injured tissues


• Clinician will palpate painful areaClinician will palpate painful area– Instruments help to magnify existing Instruments help to magnify existing

restrictionsrestrictions• Instruments allow for precise pressure Instruments allow for precise pressure

application to break up scar tissueapplication to break up scar tissue– Helps to relieve pain and restore functionHelps to relieve pain and restore function

• Specially designed lubricant is designed to Specially designed lubricant is designed to ensure that instruments glide over skinensure that instruments glide over skin


• Utilizes multi-directional cross-friction Utilizes multi-directional cross-friction massagemassage– Creates trauma and inflammatory responseCreates trauma and inflammatory response

• Initiates and promotes healing processInitiates and promotes healing process– Rehab activities and modalities should be Rehab activities and modalities should be

used in conjunctionused in conjunction


Rolfing(Structural Integration)

• Goal is to balance body within a gravitational field through manual soft tissue manipulation

• If balanced movement is essential at a particular joint but nearby tissue is restrained, both the tissue and the joint will relocate to a position which accomplishes a more appropriate equilibrium


Rolfing(Structural Integration)

• Technique involves 10 hour long sessions each of which emphasizes some aspect of posture with massage directed toward the myofascia

• Major aspect is to integrate structural with psychological and emotional aspects


• Sessions include:Sessions include:– RespirationRespiration– Balance under the body (legs and feet)Balance under the body (legs and feet)– Sagittal plane balanceSagittal plane balance– Balance right to leftBalance right to left– Pelvic balance (rectus abdominus & psoas)Pelvic balance (rectus abdominus & psoas)– Weight transfer from head to feetWeight transfer from head to feet– Relationship of head to rest of bodyRelationship of head to rest of body– Upper and lower half of body relationshipsUpper and lower half of body relationships– Head/body and upper/lower bodyHead/body and upper/lower body– Balance throughout systemBalance throughout system


Trager• Combines mechanical soft tissue

mobilization and neurophysiological reeducation

• Uses gentle, passive, rocking oscillations emphasizing traction and rotation as a relaxation technique

• Attempts to establish neuromuscular control so that more normal movement patterns can be routinely performed


• Mobilization technique that encourages patient to relinquish control

• Followed by periods of active movements designed to alter the patient’s neurophysiologic control of movement– Provides a basis for maintaining these changes

• Does not attempt to make mechanical changes• Relies on nervous system to make changes as

opposed to making mechanical changes


Indications For Massage• Increase coordination• Decrease pain • Decrease

neuromuscular excitability

• Stimulate circulation • Facilitate healing• Restore joint mobility• Remove lactic acid

• Alleviate muscle cramps• Increase blood flow• Increase venous return• Retard muscle atrophy• Increase range of motion• Edema• Myofascial trigger points• Stretching scar tissue


Indications For Massage

• Adhesions• Muscle spasm • Myositis• Bursitis• Fibrositis• Tendinitis

• Revascularization • Raynaud's disease• Intermittent

claudication• Dysmenorrhea • Headaches• migraines


Contraindications For Massage

• Arteriosclerosis• Thrombosis • Embolism• Severe varicose

veins• Acute phlebitis• Cellulitis

• Synovitis• Abscesses• Skin infections • Cancers • Acute inflammatory

conditions

therapeutic sports massage

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