1. © 2005 Therapeutic Massage Chapter 16

2. © 2005 Historical Perspective Dating back to the ancient Olympians Late 1980’s –American Massage Therapy 1992 –National Certification Examination for Therapeutic Massage and Bodywork

3. © 2005 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

4. © 2005 Basic Strokes: Effleurage Pétrissage Friction Tapotement Vibration Myofascial Release: J-Strokes Focused Stretching Skin Rolling Arm Pull / Leg Pull Diagonal Release Types of Massage

5. © 2005 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

6. © 2005 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

7. © 2005 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

8. © 2005 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

9. © 2005 Vibration “Rapid Shaking” Increases blood flow and provides systemic invigoration of tissues Mechanical devices available

10. © 2005 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

11. © 2005 J-Strokes One hand places the adhesion on stretch Other hand’s 2 nd and 3 rd fingers stroke in the opposite direction forming a ‘J’ Mobilize scar tissue

12. © 2005 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

13. © 2005 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

14. © 2005 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

15. © 2005 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

16. © 2005 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

17. © 2005 Indications Increase blood flow Facilitate healing Increase range of motion Remove edema Alleviate muscle cramps Stretch scar tissue/adhesions Decrease pain

18. © 2005 Contraindications Acute inflammatory conditions Severe varicose veins Open wounds Skin infections Failed or incomplete fracture healing Thrombophlebitis

19. © 2005 Preparation Table Linens and pillows Massage lubricant Patient position Masseuse position

20. © 2005 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

21. © 2005 Edema Reduction Massage

22. © 2005 Preparation Elevate the body area Apply massage lubricant to the skin Clinician is positioned distal to the extremity

23. © 2005 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

24. © 2005 Termination Remove medium If appropriate: –Active range of motion exercises –Compression wrap Encourage patient to drink water to assist in flushing metabolic waste