History of Massage Natural reaction to when the body hurts is to rub it Dates back to at least the ancient Olympics In Europe in the Middle Ages, the Church of Rome & its religious teachings discouraged massage as a healing practice Massage is derived from 2 sources Arabic verb mass “to touch” Greek word massein “to knead” Egyptians, Romans, Japanese, Persians, & Chinese were known to practice massage therapy
History of Massage Sweden – early 19th century, Peter Ling (acknowledged founder of curative gymnastics) – appears to be founder of modern day massage techniques, incorporated with French massage techniques Techniques have changed dramatically in the past 50 years Based on research by Albert Hoffa (1859-1907), James Mennell 1880-1957), & Gertrude Beard (1887-1971). Scientific basis to massage was added Late 1980’s, Amer. Massage Therapy Association was organized (1992 – Nat’l Cert. Exam. For Therapeutic Massage & Bodywork was formed)
What is Massage Therapy? Mechanical modality Used to manipulate the body’s tissue Effective in promoting local & systemic relaxation, increasing local b. flow, breaking down adhesions, & encouraging venous return Act of rubbing, kneading, or stroking the superficial parts of the body with the hand or an instrument for the purpose of modifying nutrition, restoring power of movement or breaking up adhesions Time-consuming
Treatment Considerations & Guidelines Need to know underlying pathology Need to know basic massage principles (must have manual dexterity, coordination, & concentration). Must also exhibit patience & courteousness. Hands must be clean, warm, dry & soft. Nails must be short and smooth. Hands should be warm. Avoid constant hyperextension or hyperflexion of any joints which may lead to hypermobility. Must obtain correct positioning that will allow for relaxation, prevent fatigue & permit free movement of arms, hands, & body.
Treatment Considerations & Guidelines 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. A good position is required to allow for correct application of pressure and rhythmic strokes during the procedure.
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. Also, massage may not be warranted on a daily basis (e.g. friction massage). Some areas may take 30 minutes.
Points for Consideration If swelling is present in an extremity, treatment should begin proximally. “Uncorking the bottle”, “uncorking effect” 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.
Points for Consideration Make sure the patient is warm and in a comfortable, relaxed position. Also, make sure the patient is properly draped. The body part may be elevated if necessary. Massage should begin with superficial stroking. Each stroke should start at the joint or just below the joint (unless contraindicated) and finish above the joint so that strokes overlap. Pressure should be in line with venous flow. Bony prominences & painful joints should be avoided if possible.
Massage Media Used to decrease friction between the patient’s skin and the clinician’s hand Massage can be given without any medium being used Lotions, peanut oil, powder, analgesic balms More medium should be used on hairy areas During petrissage – lubricants interfere with the kneading & lifting During friction massage – lubricants may interfere with the certain results you want to obtain
Massage Strokes Effleurage Petrissage Friction (circular, transverse) Tapotement Vibration Myofascial release techniques Various other forms – some may combine strokes
Physiological Effects of Massage Therapy Depending on the amount of pressure applied & the speed of the stroke, many results can occur Light, slow stroking – evokes systemic relaxation Fast, deep strokes increase blood flow to the area Cardiovascular changes – deep friction or vigorous massage was thought to produce vascular changes Research failed to support those theories No increase in cardiac output, b.p., or increased arterial b. flow were revealed Massage can produce decreased heart rate, breathing rate, & b.p. if the purpose is for inducing system relaxation
Physiological Effects Petrissage has been shown to decrease neuromuscular excitability, but only during the massage (effects confined to muscle being massaged) Deep effleurage, circular & transverse friction has shown to improve flexibility Massage is less effective in decreasing muscular recovery time, but may be effective (2 hrs post) in reducing amount of DOMS Little reduction in m. fatigue when performing between exercise (pitcher, sprinter)
Physiological Effects Edema reduction – when performed properly it can increase venous & lymphatic flow Reduces pain By decreasing pressure from swelling, mechanical pain can be reduced By interrupting m. spasm, mechanical pain can be reduced By reducing edema, mechanical pain can be reduced By increasing b. flow & encouraging waste removal, chemical pain can be reduced Activates sensory nerves – inhibits pain
Mechanical Effects Techniques that stretch a muscle, elongate fascia, or mobilize soft-tissue adhesions or restrictions are all mechanical techniques Mechanical effects are always accompanied by some reflex effects As mechanical stimulus becomes more effective, reflex stimulus becomes less effective Muscle – massage is done either for mechanical stretching or to relieve pain associated with trigger points
Mechanical Effects Skin – massage has been shown to increase skin temperature, increase sweating & decrease resistance to electrical current It has been shown to toughen yet soften the skin Acts directly on the surface of the skin to remove dead cells Stretches & breaks down fibrous tissue
Effleurage 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
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
Petrissage Lifting & kneading of skin, subcutaneous tissue, & muscles Performed with fingers or hand Skin is gently lifted between thumb & fingers or fingers & palm & gently rolled & kneaded in the hand Often performed without lotion Frees adhesions by stretching & separating muscle fiber, fascia, & scar tissue while assisting with venous return & milking out waste products
Friction Goal is to mobilize muscle & separate adhesions that restrict movement & cause pain Facilitates local blood profusion Not necessarily a “pleasing” treatment Circular: Applied with thumbs working in circular motion Effective in treating muscle spasm & trigger pts.
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
Tapotement Gentle tapping or pounding of the skin Most common form uses ulnar side of wrist to contact skin “karate chop” Wrist & fingers are usually limp, alternate method “cups” the hand Promotes relaxation & densitization of irritated nerve endings
Vibration Rapid shaking of the tissues Soothes peripheral nerves A mechanical device can be used
Myofascial Release Involves effleurage, petrissage & friction massage strokes with stretching of muscles & fascia Tries to obtain relaxation of tense and/or adhered tissues (myo – muscle; fascia – band; ease the tension of fibrous CT bands) No structured pattern Involves pulling of tissues in opposite directions, stabilizing the proximal/superior position w/ one hand while applying a stretch w/ opposite hand, or using the patient’s body weight to stabilize the extremity while a longitudinal stress is applied Can involve more than one clinician
Myofascial Release Purpose is to relieve soft tissue from abnormal grip of tight fascia May also be known as soft-tissue mobilization Treatment is based on localizing the restriction & moving into the direction of the restriction Very subjective & relies on experience of clinician Recommended to treat at least 3 x per week
Acupressure Acupressure – based on Chinese art of Acupuncture The Chinese make no distinction between arteries, veins, or nerves when explaining function of the body. Concentrate on the system of forces that regulate all bodily functions. Qi (pronounced “che” exists in everyone & controls all aspects of life) Qi is governed by two opposing forces, Yang (positive) & Yin (negative) forces. Disease results from some imbalance between these two forces. Yin & Yang pass flow through passageways/lines in the body called “jing” (Chinese) or “meridians” (West).
Acupressure 12 meridians in the body Lung (L) named according to the part Large Intestine (LI) of the body with which they Stomach (ST) are associated. The Spleen (SP) meridians on one side of the Heart (H) body are duplicated on the Small Intestine (SI) other side; however, two Urinary bladder (UB) additional meridians exist Kidney (K) that can’t be paired. Pericardium (P) Triple warmet (TW) Gall bladder (GB) *not paired Liver (LIV) Governing vessel (VB)* Conception vessel (CV)*
Acupressure Along the meridians lie the acupuncture points Whenever there is pain or illness, certain points on the surface of the body become tender When pain is eliminated, these tender spots disappear According to acupuncture theory, stimulation of specific points through needling can reduce pain in areas associated with a particular point Thousands of points have been identified
Acupressure Electrical resistance of the skin at certain points corresponding to the acupuncture points is lower than that of surrounding skin, especially when a disease state is present. Russian research has shown evidence of skin temperature difference at these points.
Myofascial Trigger Points Trigger points are the counterpart of acupuncture points May be found in muscle, tendons, myofascia, ligaments & capsules surrounding joints, in periosteum, & in the skin May activate & become painful due to trauma Stimulation of these points have resulted in pain relief
What to do…. Location of points: Use an ohmmeter to differentiate the electrical impedance of areas OR palpate the area until either a small fibrous nodule or strip of tense muscle tissue that is tender to the touch is felt. Once located, massage is begun using the thumb, index or middle fingers or the elbow. Perform small friction-like circular motions over the point. Amount of pressure should be determined by patient tolerance, and may be intense and painful. Treatment time – 1-5 minutes at a single point. Patient will report a dulling/numbing effect & will report the pain diminishes.
Rolfing May also see it is “structural integration” Goal - to balance the body within a gravitational field through a technique involving manual soft-tissue manipulation Improve balance, posture, flexibility, movement efficiency Basic principle of treatment is - if balanced movement is essential at a particular joint, yet nearby tissue is restrained, both the tissue & the joint will relocate to a position that accomplishes a more appropriate equilibrium.
Rolfing Standardized approach that is administered without regard to symptoms or pathologies Technique involves 10 hour-long sessions, each emphasizing some aspect of posture 10 sessions include: Respiration, balance under the body (legs/feet), sagittal plane balance (lateral line from front to back), balance left to right (base of body to midline), pelvic balance (rectus abdominis & psoas), weight transfer from head to feet – sacrum, relationship of head to rest of body, upper ½ of body to lower ½ of body relationship, balance throughout the system Additional “tune-up” sessions may be required Integrates structural with psychological approach