1. Therapeutic Massage
Chapter 16

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

3. 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. 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

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

8. Circular Friction Massage
Use a circular motion
Thumbs
Elbow
Commercial device

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

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

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

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

13. 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

14. 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

15. 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

16. 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

17. 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 degrees until full abduction is reached
Stretches large areas of fascia

18. 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

19. 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

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

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

22. Preparation Table Linens and pillows Massage lubricant
Patient position
Masseuse position

23. 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

24. Edema Reduction Massage

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

26. 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

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