1. Therapeutic Massage Chapter 16

2. General Overview

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

4. 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

5. Reflexive Effects –On Pain Gate control theory Endogenous Opiates release –On Circulation Somatosympathetic reflex - probably does not occur with massage, since massage is passive. Axonal reflex occurs when cutaneous afferent information travels antidromically and produces a local vasodilation

6. Reflexive Effects –On Metabolism Does not alter metabolism significantly –On Motor Neuron Activity There is an inhibition of the spinal motor neuron excitability during a massage. It is specific to that muscle with no lingering effects

7. Mechanical Effects –stretching and mobilizing tissues –mechanically increase blood flow and venous return of that muscle

8. Circulation Light exercise is more effective in increasing blood flow than massage Cellular metabolism

9. Effects on Range of Motion (ROM) Increase ROM short-term, but no Long-term effects

10. Effects on the Recovery of Muscle Function Massage appears to have no benefit on recovery of muscle function in the following situations: –muscle damage caused by eccentric overload. –recovery of post-exercise muscle strength. –reduction of delayed onset muscle soreness (DOMS). –rate of recovery of muscle function following anaerobic work.

11. Psychological You communicate compassion, concern, anger, sensual, or other emotions through touch.

12. Basic Strokes: Effleurage Pétrissage Friction Tapotement Vibration Myofascial Release: J-Strokes Focused Stretching Skin Rolling Arm Pull / Leg Pull Diagonal Release Types of Massage

13. Different types of strokes Effleurage (stroking) –Superficial or Deep Petrissage (kneading) Friction –Transverse or Longitudinal Vibration Tapotement –Percussion/slapping/hacking/beating

14. 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

15. 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

16. Friction “Deep pressure” Circular: –Use a circular motion with thumbs, elbow, or a commercial device Transverse Friction: –The thumbs or fingertips stroke in opposite directions Effects muscle mobilization, tissue separation, and trigger points

17. Tapotement “Tapping or pounding” of the skin Variations: –Hacking –Cupping –Pincement (pinching) –Rapping –Tapping Performed with a light, fast tempo Promotes muscular and systemic relaxation and desensitization of irritated nerve endings

18. Vibration “Rapid Shaking” Rolling a limb between hands (arm/leg) Increases blood flow and provides systemic invigoration of tissues Mechanical devices available

19. 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

20. J-Strokes One hand places the adhesion on stretch Other hand’s 2 nd and 3 rd fingers stroke in the opposite direction forming a ‘J’ Mobilize scar tissue

21. 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

22. 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

23. 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 10-15 degrees until full abduction is reached Stretches large areas of fascia

24. 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

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

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

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

28. 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

29. Edema Reduction Massage

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

31. 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

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

33. Application Soft Tissue Healing –Injury Protect –Inflammatory Phase Effleurage (Lymphatic) massage Light petrissage Avoid friction massage

34. Application –Fibroblastic-Repair Phase Effleurage and petrissage to reduce edema Friction to help tension the collagen for proper alignment, thus preventing adhesions. –Maturation-Remodeling Phase Patient education Pain Cycle

36. Application Chronic Injury –Friction –Petrissage –Effleurage (lymphatic)

37. (Fritz, 1995)

39. Indications & Contraindications Indications –Patients with adhesions, edema, muscle spasm, bursitis, tendinitis, tenosynovitis, strains, and sprains. Contraindications –Patients with myositis ossificans, thrombosis or embolism, severe varicose veins (caution), acute phlebitis, cellulitis, synovitis, abscesses, shin injections, and massage of a cancerous site.