Therapeutic Massage Chapter 16

Historical Perspective Dating back to the ancient Olympians Late 1980’s American Massage Therapy 1992 National Certification Examination for Therapeutic Massage and Bodywork

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

Types of Massage Basic Massage Strokes Effleurage Pétrissage Friction Tapotement Vibration Myofascial Release J-Strokes Focused Stretching Skin Rolling Arm Pull / Leg Pull Diagonal Release

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

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

Friction “Deep pressure” Effects muscle mobilization, tissue separation, and trigger points Two types: Circular Transverse

Circular Friction Massage Use a circular motion Thumbs Elbow Commercial device

Transverse Friction Massage Strokes perpendicular to tissue fibers The thumbs or fingertips stroke in opposite directions

Tapotement “Tapping or pounding” of the skin Variations: Hacking Cupping Pincement (pinching) Rapping Tapping

Tapotement Technique Performed with a light, fast tempo Promotes muscular and systemic relaxation and desensitization of irritated nerve endings

Vibration “Rapid Shaking” Increases blood flow and provides systemic invigoration of tissues Mechanical devices available

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

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

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

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

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

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

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

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

Contraindications Acute inflammatory conditions Severe varicose veins Open wounds Skin infections Failed or incomplete fracture healing Thrombophlebitis

Preparation Table Linens and pillows Massage lubricant Patient position Masseuse position

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

Edema Reduction Massage

Preparation Elevate the body area Apply massage lubricant to the skin Clinician is positioned distal to the extremity

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

Termination Remove medium If appropriate: Active range of motion exercises Compression wrap Encourage patient to drink water to assist in flushing metabolic waste