1. Massage and Traction

2.  Mechanical response  Encourage venous and lymphatic drainage  Mildly stretch superficial and scar tissues  Avoid stagnation of circulation during immobilization or when edema surrounds a joint  Physiological response  Increased circulation  Increased metabolism  Removal of metabolites (lactic acid)  Body relaxation  Stimulation

3.  Effleurage (stroking)  Light stroking: designed to be sedative, used in early stages of treatment  Deep stroking: therapeutic compression of soft tissue  Encourages venous and lymphatic drainage Light and deep stroking can be used alternatively  Hand over hand method: one hand immediately follows the other  Good for areas that are unyielding  Cross body method: hands stroke simultaneously away from the spine and then towards  Good for low back

4.  Petrissage (kneading)  Used at loose and heavy tissue areas  Pick up muscle between thumb and forefinger of eat hand rolling and twisting it in opposite directions  Kneading action rings out the muscle loosening adhesions and increasing circulation

5.  Friction  Often used over areas of thin unyielding tissues  Motions start at a central point then a circular movement is initiated with hands moving in opposite directions away from the center point  Stretch underlying tissues  Increase circulation in a joint

6.  Tapotement (percussion)  Cupping – hands are cupped so the beat emits a dull and hollow sound  Produces an invigorating and stimulating sensation and should be used until skin develops a pinkish color  Hacking – ulnar border of the hand is used as a striking surface  Only heavy muscles should be treated in this manner  Pincing – alternating hands lift small amounts of tissue between the first finger and thumb in quick gentle pinching movements

7.  Vibration  Rapid movement that produces a quivering or trembling effect  Used because of its ability to relax and soothe  Machines often used

8.  Deep Transverse Friction Massage  Move transversely across a ligament or tendon to mobilize as much as possible  Massage must be directly over the site of the lesion and pain  Fingers move with skin and do not slide over it  Do not perform to acute injuries or highly swollen tissues

9.  Acupressure Massage  Massage point of pain with the index, middle fingers, thumb or elbow using small circular motions on the point  Treatments will last 1-5 minutes over a single point  During treatment patient may report dulling or numbing effect  This indicates that the pain is diminished or subsided  Lingering effects can be a few minutes to several hours

10. The use of a pulling force to treat musculoskeletal disorders Usually applied to the cervical or lumbar vertebra

11.  Produce separation of vertebral bodies  Stretching of ligaments or joint capsule  Stretching of spinal and paraspinal muscles  Increased separation of articular facet joints  Relief in pressure on nerves and nerve roots  Decrease in central pressure of the intervertebral discs  Increase and change in joint proprioception  Relief of the compressive effects of normal pressure

12.  Spinal nerve root impingement  Disc herniation, spondylolisthesis  Decreased muscle guarding  Treat muscle strain  Treat sprain of spinal ligaments  Relax discomfort resulting from normal spinal compression

13.  Manual Traction – more adaptable and offers greater flexibility  Changes in force, direction, duration, patient position can be made instantaneously  Mechanical Traction – musct be used to allow for smooth nonrestricted traction  Positional Traction – used on a trial and error basis to determine the maximum position of comfort or to accomplish a specific treatment goal  Wall-Mounted Traction – cervical traction  Plates, sand bags or water bags can be used for weights  Inverted traction – places person in an inverted position where stretch is provided by the weight of the trunk

14.  Lumbar – sustained traction most effective  Intermittent traction is the most comfortable  Progressive traction will allow the patient to adapt slowly and keep them relaxed  Lumbar traction force can be up to 50% of body weight  Cervical traction force 20-50 lbs depending on the patient’s comfort and response