1. © 2009 McGraw-Hill Higher Education. All rights reserved. Chapter 13: Massage

2. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

3. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

4. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

5. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

6. © 2009 McGraw-Hill Higher Education. All rights reserved. Effects on MetabolismEffects on Metabolism –Does not alter general metabolism –No alterations in acid-base equilibrium of blood –No significant effects on cardiovascular system –Assists in removal and hastens resynthesis of lactic acid Effects on MetabolismEffects on Metabolism –Does not alter general metabolism –No alterations in acid-base equilibrium of blood –No significant effects on cardiovascular system –Assists in removal and hastens resynthesis of lactic acid

7. © 2009 McGraw-Hill Higher Education. All rights reserved. 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. 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.

8. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

9. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

10. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

11. © 2009 McGraw-Hill Higher Education. All rights reserved. Treatment Considerations and Guidelines Knowledge of anatomy essential Understanding of existing pathology Thorough knowledge of massage principles Knowledge of anatomy essential Understanding of existing pathology Thorough knowledge of massage principles

12. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

13. © 2009 McGraw-Hill Higher Education. All rights reserved. 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"  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"

14. © 2009 McGraw-Hill Higher Education. All rights reserved.  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  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

15. © 2009 McGraw-Hill Higher Education. All rights reserved.  Stroke should overlap  Pressure should be in line with venous flow followed by a return stroke  All strokes should be rhythmic  Stroke should overlap  Pressure should be in line with venous flow followed by a return stroke  All strokes should be rhythmic

16. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

17. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

18. © 2009 McGraw-Hill Higher Education. All rights reserved. Massage Treatment Techniques

19. © 2009 McGraw-Hill Higher Education. All rights reserved. Hoffa Massage Classical massage technique which uses a variety of superficial strokes –Effleurage –Petrissage –Tapotement –Vibration Classical massage technique which uses a variety of superficial strokes –Effleurage –Petrissage –Tapotement –Vibration

20. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

21. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

22. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

23. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

24. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

25. © 2009 McGraw-Hill Higher Education. All rights reserved. Tapotment (Percussion) Hacking

26. © 2009 McGraw-Hill Higher Education. All rights reserved. Tapotment (Percussion) Hacking Slapping Hacking Slapping

27. © 2009 McGraw-Hill Higher Education. All rights reserved. Tapotment (Percussion) Hacking Slapping Beating Hacking Slapping Beating

28. © 2009 McGraw-Hill Higher Education. All rights reserved. Tapotment (Percussion) Hacking Slapping Beating Tapping Hacking Slapping Beating Tapping

29. © 2009 McGraw-Hill Higher Education. All rights reserved. Tapotment (Percussion) Hacking Slapping Beating Tapping Clapping or cupping Hacking Slapping Beating Tapping Clapping or cupping

30. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

31. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

32. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

33. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

34. © 2009 McGraw-Hill Higher Education. All rights reserved. Connective Tissue Massage (Bindegewebsmassage) 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 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

35. © 2009 McGraw-Hill Higher Education. All rights reserved. Connective Tissue Massage (Bindegewebsmassage) 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 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

36. © 2009 McGraw-Hill Higher Education. All rights reserved. IndicationsIndications –Scars on the skin –Fractures and arthritis in bones and joints –Low back pain –Varicose symptoms, thrombophlebitis, hemorrhoids, edema in blood and lymph –Raynaud’s disease, intermittent claudication, frostbite –Myocardial dysfunctions, respiratory disturbances –Intestinal disorders, ulcers, hepatitis, amenorrhea, dysmenorrhea, genital infantilism, Parkinson’s disease, migraines IndicationsIndications –Scars on the skin –Fractures and arthritis in bones and joints –Low back pain –Varicose symptoms, thrombophlebitis, hemorrhoids, edema in blood and lymph –Raynaud’s disease, intermittent claudication, frostbite –Myocardial dysfunctions, respiratory disturbances –Intestinal disorders, ulcers, hepatitis, amenorrhea, dysmenorrhea, genital infantilism, Parkinson’s disease, migraines

37. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

38. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

39. © 2009 McGraw-Hill Higher Education. All rights reserved. Latent trigger pointsLatent trigger points –Don’t cause spontaneous pain, may restrict movement Active trigger pointsActive trigger points –Causes pain at rest –Tender to palpation with referred pain –Identification: Patient has persistent regional pain resulting in decreased ROMPatient has persistent regional pain resulting in decreased ROM Hypersensitive nodules  palpation results in pain in the area and radiation of painHypersensitive nodules  palpation results in pain in the area and radiation of pain Contracting involved muscle  increases painContracting involved muscle  increases pain Firm pressure usually elicits “jump sign”Firm pressure usually elicits “jump sign” Latent trigger pointsLatent trigger points –Don’t cause spontaneous pain, may restrict movement Active trigger pointsActive trigger points –Causes pain at rest –Tender to palpation with referred pain –Identification: Patient has persistent regional pain resulting in decreased ROMPatient has persistent regional pain resulting in decreased ROM Hypersensitive nodules  palpation results in pain in the area and radiation of painHypersensitive nodules  palpation results in pain in the area and radiation of pain Contracting involved muscle  increases painContracting involved muscle  increases pain Firm pressure usually elicits “jump sign”Firm pressure usually elicits “jump sign”

40. © 2009 McGraw-Hill Higher Education. All rights reserved. Acupressure and trigger point massage are very similarAcupressure and trigger point massage are very similar –Independently discovered but rely on similar underlying neural mechanisms Treatment effectiveness may be result of intense, low-frequency stimulation of trigger points and release of  - endorphinsTreatment effectiveness may be result of intense, low-frequency stimulation of trigger points and release of  - endorphins Acupressure and trigger point massage are very similarAcupressure and trigger point massage are very similar –Independently discovered but rely on similar underlying neural mechanisms Treatment effectiveness may be result of intense, low-frequency stimulation of trigger points and release of  - endorphinsTreatment effectiveness may be result of intense, low-frequency stimulation of trigger points and release of  - endorphins

41. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

42. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

43. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

44. © 2009 McGraw-Hill Higher Education. All rights reserved. Strain-Counterstrain Physiological rationale –Stretch reflex –Muscle is placed on slack, reducing muscle spindle input –Facilitates relaxation and hence decrease tension and pain Physiological rationale –Stretch reflex –Muscle is placed on slack, reducing muscle spindle input –Facilitates relaxation and hence decrease tension and pain

45. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

46. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

47. © 2009 McGraw-Hill Higher Education. All rights reserved. Active Release Therapy

48. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

49. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

50. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

51. © 2009 McGraw-Hill Higher Education. All rights reserved. Myofascial Release Technique Preparing clinician’s hands Use limited lubricant Positioning critical to maximize effects of treatment Preparing clinician’s hands Use limited lubricant Positioning critical to maximize effects of treatment

52. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

53. © 2009 McGraw-Hill Higher Education. All rights reserved. Clinician will palpate painful areaClinician will palpate painful area –Instruments help to magnify existing restrictions Instruments allow for precise pressure application to break up scar tissueInstruments allow for precise pressure application to break up scar tissue –Helps to relieve pain and restore function Specially designed lubricant is designed to ensure that instruments glide over skinSpecially designed lubricant is designed to ensure that instruments glide over skin Clinician will palpate painful areaClinician will palpate painful area –Instruments help to magnify existing restrictions Instruments allow for precise pressure application to break up scar tissueInstruments allow for precise pressure application to break up scar tissue –Helps to relieve pain and restore function Specially designed lubricant is designed to ensure that instruments glide over skinSpecially designed lubricant is designed to ensure that instruments glide over skin

54. © 2009 McGraw-Hill Higher Education. All rights reserved. Utilizes multi-directional cross-friction massageUtilizes multi-directional cross-friction massage –Creates trauma and inflammatory response Initiates and promotes healing processInitiates and promotes healing process –Rehab activities and modalities should be used in conjunction Utilizes multi-directional cross-friction massageUtilizes multi-directional cross-friction massage –Creates trauma and inflammatory response Initiates and promotes healing processInitiates and promotes healing process –Rehab activities and modalities should be used in conjunction

55. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

56. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

57. © 2009 McGraw-Hill Higher Education. All rights reserved. Sessions include:Sessions include: –Respiration –Balance under the body (legs and feet) –Sagittal plane balance –Balance right to left –Pelvic balance (rectus abdominus & psoas) –Weight transfer from head to feet –Relationship of head to rest of body –Upper and lower half of body relationships –Head/body and upper/lower body –Balance throughout system Sessions include:Sessions include: –Respiration –Balance under the body (legs and feet) –Sagittal plane balance –Balance right to left –Pelvic balance (rectus abdominus & psoas) –Weight transfer from head to feet –Relationship of head to rest of body –Upper and lower half of body relationships –Head/body and upper/lower body –Balance throughout system

58. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

59. © 2009 McGraw-Hill Higher Education. All rights reserved. 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 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

60. © 2009 McGraw-Hill Higher Education. All rights reserved. Indications For Massage Increase coordination Decrease pain Decrease neuromuscular excitability Stimulate circulation Facilitate healing Restore joint mobility Remove lactic acid 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 Alleviate muscle cramps Increase blood flow Increase venous return Retard muscle atrophy Increase range of motion Edema Myofascial trigger points Stretching scar tissue

61. © 2009 McGraw-Hill Higher Education. All rights reserved. Indications For Massage Adhesions Muscle spasm Myositis Bursitis Fibrositis Tendinitis Adhesions Muscle spasm Myositis Bursitis Fibrositis Tendinitis Revascularization Raynaud's disease Intermittent claudication Dysmenorrhea Headaches migraines Revascularization Raynaud's disease Intermittent claudication Dysmenorrhea Headaches migraines

62. © 2009 McGraw-Hill Higher Education. All rights reserved. Contraindications For Massage Arteriosclerosis Thrombosis Embolism Severe varicose veins Acute phlebitis Cellulitis Arteriosclerosis Thrombosis Embolism Severe varicose veins Acute phlebitis Cellulitis Synovitis Abscesses Skin infections Cancers Acute inflammatory conditions Synovitis Abscesses Skin infections Cancers Acute inflammatory conditions