1. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 7: Superficial Reflex Techniques Outcome-Based Massage: Putting Evidence into Practice

2. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Objectives At the end of this presentation you will have the information needed to: Describe how the massage techniques in this category affect different types of tissues. Describe each massage technique in terms of the contact surface, pressure, tissues engaged, amplitude, direction, and rate. Demonstrate how to perform each massage technique and how to apply it in the context of a practice sequence. Speculate about the mechanisms by which massage techniques achieve their effects. Describe the outcomes of care, indications, contraindications and common uses associated with each massage technique.

3. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Definitions Superficial: pertaining to or situated near the surface Reflex: an involuntary reaction in response to a stimulus applied to the periphery and transmitted to the nervous centers in the brain or spinal cord

4. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflex effects of massage Are mediated by the nervous system Peripheral receptors send impulses to centers in the brain or spinal cord which then… …cause a local or systemic response E.g., stroking a person’s hand at the right rate and rhythm can cause drowsiness

5. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Mechanical effects of massage Are caused by physically moving tissues, by: –compressing –stretching –shearing –bending –twisting e.g., stretching scar tissue causes it to lengthen

6. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Superficial reflex techniques Engage the skin, and affect level of arousal, autonomic balance, or perception of pain Include: –static contact –superficial stroking –fine vibration

7. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Static contact Motionless contact of the therapist’s hands with the client’s body, performed with minimal force The least mechanically forceful of the massage techniques An important part of systems such as Therapeutic Touch, Reiki, and Polarity Therapy

8. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Static contact: outcomes and uses Increases rapport Decreases anxiety, improves relaxation Analgesia May improve growth of premature infants Is used to assist with client education May affect client’s electromagnetic field

9. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Static contact: contraindications and cautions Areas of acute inflammation, because of pain Clients who have much pain or distress may not tolerate touch at all Be sensitive to the needs of frail, high risk, or terminally ill clients Even though static contact causes minimal mechanical effects, it can give rise to complex physical and emotional responses, including touch triggered memory

10. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Performing static contact Use a relaxed upright posture and fully relaxed hands Breathe using your diaphragm Encourage relaxation and diaphragmatic breathing in your client Observe client for signs of relaxation For a relaxation response, try applying static contact to the client’s occiput, sacrum, face, hands, or feet

11. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Static contact applied to the occiput

12. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Static contact used to teach breathing

13. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Superficial stroking Gliding over the client’s skin with minimal deformation of subcutaneous tissues Usually applied unidirectionally over large areas of the client’s body Often used at the beginning or end of a region or intervention

14. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Superficial stroking: outcomes and uses Reduces pain Improves mood and reduces anxiety Changes level of arousal (alertness) Improves growth of premature infants May alter level of neuromuscular tone

15. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Superficial stroking: contraindications and cautions Areas of acute inflammation, because of pain Clients who have much pain or distress may not tolerate touch at all Be sensitive to the needs of frail, high risk, or terminally ill clients Recent myocardial infarction With bypass surgery, wait 48 hrs. Ticklishness: use a broader contact, more lubricant, or more pressure

16. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Performing sedative stroking Use: –relaxed contact with the entire palmar surface –slow, stable rate –caudal direction (down limbs and back)

17. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Performing stimulating stroking Use: –fingertip contact –fast irregular rate –multidirectional strokes

18. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Superficial stroking of the face

19. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Superficial palmar stroking of the back

20. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Fine vibration Fast oscillating or trembling movement produced on the client’s skin with minimal deformation of subcutaneous tissues Manual technique is hard to perform long enough to be effective Perform using a machine that vibrates at 100 Hz

21. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Fine vibration: outcomes and uses Analgesia for both acute pain and chronic pain Improves ability of clients with neurological problems to perform exercise (through temporarily raised neuromuscular tone)

22. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Fine vibration: contraindications and cautions When pain is due to acute inflammation, the weight of the hand or of a machine may not be tolerated locally

23. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Performing fine vibration Analgesia is much greater when: –vibration is applied continuously for longer than 30 minutes –rate is 100+ Hz So use a machine! You can attach it to the client, freeing your hands to perform other manual techniques

24. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins Using a fine vibration machine

25. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins References The references for the material in this presentation are found in Chapter 7: Superficial Reflex Techniques