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Therapeutic Massage

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Historical Perspective

• Dating back to the ancient Olympians

• Late 1980’s – American Massage Therapy

• 1992 – National Certification Examination for

Therapeutic Massage and Bodywork

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Purpose

• Manipulates the the body’s tissues to:– Reduce muscle spasm– Promote relaxation– Improve blood flow– Increase venous drainage

• Broad range of massage theories, techniques, and effects

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• Basic Strokes:• Effleurage• Pétrissage• Friction• Tapotement• Vibration

• Myofascial Release:• J-Strokes• Focused Stretching• Skin Rolling• Arm Pull / Leg Pull• Diagonal Release

Types of Massage

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Effleurage• “Stroking of the skin”• Spread massage lubricant• Use at the beginning and end of the massage• Superficial:

– slow strokes for relaxation

• Deep: – Elongates muscle fibers– Stretches fascia– Forces fluids in the direction of the stroke

• towards the heart

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Pétrissage

• “Lifting and kneading”

• Frees adhesions:– Stretches and separates muscle fiber, fascia, and

scar tissue

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

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Friction

• “Deep pressure”• Circular:

– Use a circular motion with thumbs, elbow, or a commercial device

• Transverse Friction:– The thumbs or fingertips stroke in opposite

directions

• Effects muscle mobilization, tissue separation, and trigger points

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Tapotement

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

– Hacking– Cupping– Pincement (pinching)– Rapping– Tapping

• Performed with a light, fast tempo• Promotes muscular and systemic relaxation and

desensitization of irritated nerve endings

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Vibration

• “Rapid Shaking”

• Increases blood flow and provides systemic invigoration of tissues

• Mechanical devices available

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Myofascial Release

• Stroking and stretching of tissues:– Relax tense tissues

– Release adhered tissues

– Restore tissue mobility

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

• Specialized training in myofascial release techniques is needed to become proficient in these skills

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J-Strokes

• One hand places the adhesion on stretch

• Other hand’s 2nd and 3rd fingers stroke in the opposite direction forming a ‘J’

• Mobilize scar tissue

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Focused Stretching

• Heel of one hand in the area of restriction

• Heel of other hand crossed in front

• Stretch the tissue using slow, deep pressure

• Reduces superficial or deep adhesions

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Skin Rolling

• Use fingers and thumb to lift and separate the skin from the underlying tissue– Similar to Pétrissage

• Roll skin between fingers noting restriction

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

• Reduces superficial myofascial adhesions

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Arm Pull/Leg Pull

• Arm pull (example):

• Grasp extremity proximal to wrist

• Apply gentle traction that is in line with anterior deltoid

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

• Stretches large areas of fascia

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Diagonal Release

• One clinician grasps the leg proximal to talocrural joint

• Other grasps the opposite arm proximal to wrist

• Keep extremities horizontal to each other

• One moves the limb until adhesions are felt while the other stabilizes the extremity

• Stretch large area of fascia

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Physiological Effects

• Cardiovascular– Increase blood flow, histamine release, and temperature– Decreased heart rate, respiratory rate, and blood pressure

• Neuromuscular– Increase flexibility, decrease neuromuscular excitability

(relaxation), edema reduction, and stretch muscle and scar tissue

• Pain– Activate spinal gate and the release of endogenous opiates

• Psychological– Reduces patient anxiety, depression, and mental stress

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Indications

• Increase blood flow• Facilitate healing• Increase range of motion• Remove edema• Alleviate muscle cramps• Stretch scar tissue/adhesions• Decrease pain

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Contraindications

• Acute inflammatory conditions

• Severe varicose veins

• Open wounds

• Skin infections

• Failed or incomplete fracture healing

• Thrombophlebitis

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Preparation

• Table

• Linens and pillows

• Massage lubricant

• Patient position

• Masseuse position

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Traditional Massage

• Apply massage medium with light, slow

• Build to deeper effleurage

• Pétrissage

• Wipe medium before applying deep friction (if applicable)

• Reapply pétrissage and deep effleurage

• End with light effleurage

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Edema Reduction Massage

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Preparation

• Elevate the body area

• Apply massage lubricant to the skin

• Clinician is positioned distal to the extremity

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Stroke Sequence

• Begin proximal to the edematous area

• Long, slow, deep strokes towards the torso

• Move starting point slightly distal every fourth or fifth stroke

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

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Termination

• Remove medium

• If appropriate:– Active range of motion exercises– Compression wrap

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

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