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Therapeutic Sports Massage
Jennifer Doherty-Restrepo, ATC, LAT Entry-Level Athletic Training Education Program PET 4995: Therapeutic Modalities
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Physiologic Effects of Massage
Mechanical stimulation of tissues by rhythmically applied pressure and stretching Effects of massage may be either ___________, or ___________ Effects differ depending on method utilized, pressure exerted, and duration of massage
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Physiologic Effects of Massage
___________ Effects sensory and motor nerves locally Elicits some central nervous system response (ie: sedation) Makes mechanical or histological changes in myofascial structures through direct force applied superficially
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Reflexive Effects Attempts to exert effects through ______ and superficial connective tissues Contact stimulates _________ receptors Reflex mechanism is believed to be an autonomic nervous system phenomenon The reflex stimulus causes Sedation, Relieves tension, and Increases blood flow
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Reflexive Effects cont.
Effects on Pain Modulates pain through Gate Control & -Endorphins theories Effects on Circulation Increases blood and lymphatic flow Effects on Metabolism Does not alter general metabolism Increases fresh blood and oxygen to area Assists in removal of lactic acid
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Mechanical Effects Techniques which stretch a muscle, elongate fascia, or mobilize soft tissue adhesions/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.
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Mechanical Effects Effects on Muscle
Mechanical stretching of intramuscular connective tissue to relieve pain and discomfort associated with myofascial trigger points Increases blood flow to skeletal muscle Slows muscle atrophy following injury Increases range of motion Does not increase strength or muscle tone
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Mechanical Effects cont.
Effects on Skin Increases skin temperature Increases sweating Decreases skin resistance to galvanic current Mechanically loosens adhesions and softens scar tissue Stretches and breaks down fibrous scar tissue Breaks down adhesions between skin and subcutaneous tissue
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Psychologic Effects of Massage
Psychologic effects of massage can be as beneficial as physiologic effects ” ___________" modality where patients feel as if someone is helping them
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Treatment Considerations and Guidelines
Knowledge of ___________ is essential Understanding of existing pathology Thorough knowledge of massage principles
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Positioning of Clinician
Prevent ___________ Permit free movement of arms, hands, and body Evenly distribute weight by shifting from one foot to the other Fit your hands to the contour of area being treated Hands should be clean, warm, dry, and soft
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Treatment Techniques Pressure regulation Rhythm Duration
Determined by the type and amount of tissue present and patient's condition Rhythm Must be steady and even Strokes should overlap Duration Depends on the pathology, size of the area being treated, speed of motion, age, size, and condition
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Treatment Techniques Swelling
Begin proximally to facilitate lymphatic flow “___________“ Body part may be elevated if necessary Direction of forces should parallel muscle fibers Make sure patient is warm and in a comfortable, relaxed position Massage should never be ___________
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Treatment Techniques Sufficient lubricant should be used
Begin with superficial stroking to spread lubricant Begin and end with ___________ Pressure should be in line with venous flow followed by a return stroke
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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, and powder
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Preparation of Patient
Patient should be in a relaxed, comfortable position Part involved in treatment must be adequately supported Prone, supine, seated Patient should appropriately draped
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Hoffa Massage Classical massage technique which uses a variety of superficial strokes Effleurage Petrissage Tapotment Vibration
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Every massage begins and ends with effleurage!
Any stroke that glides over skin without attempting to move deep muscles Hands are molded to treatment area Apply constant pressure moving toward _______ Lighter pressure applied on the return stroke Every massage begins and ends with effleurage!
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Effleurage cont. Moderate pressure according to patient and condition
Deep stroking is a form of effleurage, except it is given with more pressure to produce a mechanical effect Increases venous and lymphatic return Increases circulation to skin surface
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Petrissage Kneading manipulations
Muscles are gently lifted, rolled, and released Pressure is applied intermittently Hands may remain stationary or move along length of muscle or limb
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Petrissage cont. Increases venous and lymphatic return
Removes metabolic waste products Breaks up adhesions between skin and underlying tissue
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Tapotment Percussion massage Increases circulation and blood flow
Series of rapid, brisk blows Increases circulation and blood flow Stimulates peripheral nerve endings
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Tapotment cont. Hacking
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Tapotment cont. Hacking Slapping
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Tapotment cont. Hacking Slapping Beating
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Tapotment cont. Hacking Slapping Beating Tapping
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Tapotment cont. Hacking Slapping Beating Tapping Clapping or cupping
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Vibration Shaking massage
Tremulous movement made by hand or fingers placed firmly against a body part Rhythmical trembling movement will come from ___________ Hands should remain in contact with the body part
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Transverse Friction Massage
Technique used for treating chronic tendon inflammation or connective tissue adhesions Stimulates ___________ ___________ to progress healing process Apply small circular motions penetrating to deeper tissues Apply strong pressure in ___________ direction to fibers for 7 to 10 minutes every other day
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Acupresure and Myofascial Trigger Point Massage
Acupressure points are based on ancient Chinese art of acupuncture Myofascial trigger points found in… Muscle and tendon myofascia Ligaments and capsules surrounding joints Periosteum Acupressure points and myofascial trigger points are similar
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Acupresure and Myofascial Trigger Point Massage
Pain results due to inflammatory response following direct trauma or overuse Pain usually referred to areas which follow a specific pattern Stimulation of these points has been demonstrated to result in pain relief
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Acupressure Massage Techniques
Locate points from chart Use fingers, or elbow, to apply 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 minutes at several points
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Myofascial Release Also called soft tissue mobilization
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 Based on localizing restriction and moving into the direction of the restriction Myofascial manipulation is subjective and relies heavily on the experience of the clinician
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Myofascial Release Technique
Protecting the clinician’s hands Use fist or elbow if necessary Use limited lubricant Avoid slipping of hands on the skin Positoning of the patient is critical Maximize effects of treatment
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Indications For Massage
Increase coordination Decrease pain Decrease neuromuscular excitibility 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
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Indications For Massage
Adhesions Muscle spasm Myositis Bursitis Fibrositis Tendinitis Revascularization Raynaud's disease Intermittent claudication Dysmenorrhea Headaches Migraines
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Contraindications For Massage
Arteriosclerosis Thrombosis Embolism Severe varicose veins Acute phlebitis Cellulitis Synovitis Abscesses Skin infections Cancers Acute inflammatory conditions
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