2011Dr: Mosab

Therapeutic Massage

What is massage?• Massage is a mechanical stimulation of

the tissues by means of rhythmically applied pressure and stretching

Massage is a systematic manual application of pressure andmovement to the soft tissue of the body--the skin, muscles, tendons, ligaments, and fascia (the membrane surrounding muscles and muscle groups).

• The most important tools in massage are:

– The clinicians hands

– The setting

– The patient’s comfort

– Knowing which type of massage to use2011Dr: Mosab

Why massage is used

• To increase flexibility, coordination, venous return , and blood flow

• to decrease neuromuscular excitability and pain• To stimulate circulation• To facilitate healing and restore joint mobility• To remove lactic acid and edema• To treat pursitis, tendonitis, muscle spasm

Dr- mosab-2011

Purpose

• Manipulates the body’s tissues to:– Reduce muscle spasm– Promote relaxation– Improve blood flow– Increase venous drainage

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physiological effects of massage

The physiological effects of Massage include:

1- Mechanical

2- physiological

- on the circulatory system

- on the nervous system

- on the musculoskeletal system

3- psychological

Mechanical effects ofmassage

• Mechanical effects are always accompanied by some reflexive effects

• Mechanical techniques stretch a muscle, elongate fascia, or mobilize soft tissue adhesions

• Effects muscle and skin

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The Muscular System

• Relieves , tension, and stiffness

• Improves muscle tone

• Increases flexibility and range of motion of joints

• Improves the flow of nutrients to muscles and joints

• Reduces scar tissue

• Breaks down or prevents adhesions

• Enhances freedom of movement

• Prevents muscular atrophy, resulting from inactivity caused by injury, age, surgery, or illness

• Increases physical confidence

• Relieves cramps and muscle spasms

• Reduces pain and swelling

The Skeletal System

• Improves posture/body alignment

• Relieve stiff joints

• Decreases inflammation

• Restores range of motion (increasing joint movement)

• Releases joint strain (releasing tight muscles and tendons)

• Releases restrictions in the fascia (connected tissues)

• Improves the circulation and nutrients of your joints

The Circulatory System• Increases blood flow (to tissues and organs), which can relieve

much muscular and joint pain (especially associated with swelling)

• Increases the flow of oxygen and nutrients (to cells and tissues), improving and relieving congestion throughout the body

• Increases the number of red blood cells, especially in cases of anemia

• Lower blood pressure

• Reduces heart rate (helps develop a stronger heart)

• Elimination of metabolic waste

The Nervous System

• Stimulates Nervous System = boosting energy

• Calms the Nervous System = relaxing-- Massage may have a sedative, stimulating or an exhausting effect on the nervous system depending on the type and length of massage treatment given

• Relieves restlessness and insomnia

• Relieves pain due to pinched nerves

• Decreases chronic pain

• Stimulates the release of endorphins (the body's natural painkiller)

psychological effects of massage• Increases awareness of mind-body connection!

• Massage can help you become more aware of where you are holding tension, as well as where you have tight muscles or painful areas

• Massage reduces mental stress and Decreases angry feelings

• Promotes better sleep and sleep patterns

• Massage induces mental relaxation

• Fosters peace of mind

• Massage helps improve concentration

• Provides mental clarity

• Revitalizes your mind

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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 , Thrombosis• Pregnant women• Immediately after surgery

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Treatment Considerations & Guidelines

• Need to know underlying pathology• Need to know basic massage principles (must have manual

dexterity, coordination, & concentration). • Hands must be clean, warm, dry & soft. Nails must be short

and smooth. Hands should be warm.

• Must obtain correct positioning that will allow for relaxation, prevent fatigue & permit free movement of arms, hands, & body.

• Must obtain good posture to prevent fatigue & backache. • Weight should be evenly distributed on both feet.• You must be able to fit your hands to the contour of the area

being treated.

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Points for Consideration

• Pressure regulation should be determined by the type & amount of tissue present. Also, pressure is governed by the condition & which tissues are affected.

• Each stroke must have equal pressure & time (rhythm present).

• Duration depends on pathology, size of area, speed of motion, age, size, & condition of athlete. – Some areas may take 30 minutes.

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• If swelling is present in an extremity, treatment should begin proximally.

• Massage should never be painful, except possibly for friction massage. It should not cause ecchymosis.

• Direction of forces should be applied in the direction of the muscle fibers.

• Each session should begin & end with effleurage.

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• Make sure the patient is warm and in a comfortable, relaxed position.

• The body part may be elevated if necessary.

• Pressure should be in line with venous flow.

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Effects on skin

• Increase skin temperature• Friction massage can loosen adhesionsand soften scars• Toughens yet softens the skin

Effects on muscle(s)

• Increases blood flow to skeletal muscle.

• Retard muscle atrophy but does not increase strength or bulk of muscle

• Increase range of motion

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Modes of Therapeutic Massage

• Stroking• Effleurage• Friction• Kneading• Wringing • Picking up• Hacking• Shaking & Vibration 2011

Stroking - Stroking is performed with the whole hand or fingers. It comprises the usage of relaxed hand over the patient's skin with a rhythm and pressure that produce a relaxing effect.

Effleurage - Effleurage is performed by spreading and moving the hands with pressure and speed, to gain relaxation and lymph drainage.

Kneading - Kneading involves alternate compression and release of the part to be manipulated.

Picking up - Picking up involves lifting up of tissue from underlying bone, releasing it after squeezing it.

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Wringing -Wringing technique lifts up the tissue and applies a twist to enhance stretching effect.

Friction - Friction is a small movement applied with thumb or finger where pressure is applied from superficial to depth of the tissue.

Hacking - Hacking is performed with extended forearm and striking the skin using the side of the hand .

Clapping -Clapping is done by striking the skin with cupped hands.

Shaking and Vibration -Shaking and vibration involves gentle strokes of shakes and vibrations respectively

Effleurage

• Use at the beginning and end of the massage

• Stroking of the skin

• Performed with palm of hand

– Stimulates deep tissues

• Performed with fingertips

– Stimulates sensory nerves

• Superficial, rhythmic stroking:

– Contours the body or relates to direction of underlying muscles

• Deep stroking:

– Follows course of veins & lymph vessels© 2005

Effleurage

• May be performed slowly for relaxation or rapidly to encourage blood flow & stimulate the tissues

• Performed in rhythmic manner• One hand should always be in contact w/ skin• Light effleurage is performed at beginning & end of massage

or may be used between petrissage strokes– At beginning – relaxes patient & indicates area to be

treated– At end – calms down any irritated areas

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Technique/ Procedure

– Effleurage• The therapist provides lightor deep strokes of the palmsand fingers• Unidirectional circular motions(Distal to proximal)should be made movingtowards the heart• Generous lubrication isrequired

Petrissage- Lifting & kneading of skin, subcutaneous tissue, & muscles

– Repeated grasping, pressure, lifting and rolling

of muscle tissue with the thumbs and fingers

– As if “kneading” the muscles

– Performed from the distal to proximal portion

of the muscle, Performed with fingers or hand

– Kneading performed either parallel or

perpindicular to the muscle fibers

– Little lubrication is required

Friction Massage

• Indications

– Loosen adhesions, aid in edema absorption, reduce local muscular spasm

– Produce a reflex effect to remove “knots

• Contraindications

– Acute inflammation5,6,7

– *Refer to Hoffa contraindications5,6,7

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Friction Massage

• Superficial tissue manipulation over a small area

• Technique/ Procedure

– Uses the tips of the fingers, thumb, or heel of the hands

– A small circular motion of deep pressure is provided

– The skin is moved over the underlying tissues

– Lubrication is not recommended5,6,7

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Friction

• Transverse: – Applied with thumbs or fingertips stroking the tissue

from opposite directions– Can use elbow, end of rolling pin, etc. for larger areas– Reaches deep tissues– Begin lightly and then move to firmer strokes– Muscle should be placed in relaxed position– Should be avoided in acute conditions– Effective in tendonitis or other joint adhesions

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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

– Hands or fingers are placed firmly over the treatment area

– Fine rhythmical trembling is produced

from the entire forearm into the hands

– Hands should remain in constant contact

with the athlete6,7

– No lubrication is required

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Historical Perspective

• Dating back to the ancient Olympians

• Late 1980’s – American Massage Therapy

• 1992 – National Certification Examination for

Therapeutic Massage and Bodywork

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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

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• Basic Strokes:• Effleurage• Pétrissage• Friction• Tapotement• Vibration

• Myofascial Release:• J-Strokes• Focused Stretching• Skin Rolling• Arm Pull / Leg Pull• Diagonal Release

Types of Massage

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Effleurage• “Stroking of the skin”• 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

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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

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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

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Vibration

• “Rapid Shaking”

• Increases blood flow and provides systemic invigoration of tissues

• Mechanical devices available

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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

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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

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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

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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

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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

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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

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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

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Preparation

• Table

• Linens and pillows

• Massage lubricant

• Patient position

• Masseuse position

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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

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Preparation

• Elevate the body area

• Apply massage lubricant to the skin

• Clinician is positioned distal to the extremity