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Transcript of © 2005 Therapeutic Massage Chapter 16. © 2005 Historical Perspective Dating back to the ancient...
Therapeutic Massage
Chapter 16
Historical Perspective
• Dating back to the ancient Olympians
• Late 1980’s – American Massage Therapy
• 1992 – National Certification Examination for
Therapeutic Massage and Bodywork
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
• Basic Strokes:• Effleurage• Pétrissage• Friction• Tapotement• Vibration
• Myofascial Release:• J-Strokes• Focused Stretching• Skin Rolling• Arm Pull / Leg Pull• Diagonal Release
Types of Massage
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
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
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
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
Vibration
• “Rapid Shaking”
• Increases blood flow and provides systemic invigoration of tissues
• Mechanical devices available
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
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
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
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
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
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
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
Indications
• Increase blood flow• Facilitate healing• Increase range of motion• Remove edema• Alleviate muscle cramps• Stretch scar tissue/adhesions• Decrease pain
Contraindications
• Acute inflammatory conditions
• Severe varicose veins
• Open wounds
• Skin infections
• Failed or incomplete fracture healing
• Thrombophlebitis
Preparation
• Table
• Linens and pillows
• Massage lubricant
• Patient position
• Masseuse position
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
Edema Reduction Massage
Preparation
• Elevate the body area
• Apply massage lubricant to the skin
• Clinician is positioned distal to the extremity
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
Termination
• Remove medium
• If appropriate:– Active range of motion exercises– Compression wrap
• Encourage patient to drink water to assist in flushing metabolic waste