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Therapeutic Massage


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Therapeutic Massage

  1. 1. Therapeutic Massage Adapted from Therapeutic Modalities: Art & Science , Knight & Draper (2008) for KIN 195
  2. 2. What Is Massage & Why Use It? <ul><li>Systematic manual manipulation of the body’s tissues to restore normal function </li></ul><ul><li>In North America, massage is considered to be alternative medicine. </li></ul><ul><li>Elsewhere, it has been regarded as an important component of mainstream health care. </li></ul>
  3. 3. Use & Abuse of Sports Massage <ul><li>Therapeutic sports massage can be a valuable tool. </li></ul><ul><li>Athletes abuse it when a proper cool down is all they need. </li></ul><ul><li>Important that athletes perform a proper cool down after each workout and athletic competition. </li></ul>
  4. 4. Use & Abuse of Sports Massage (cont.) <ul><li>Many types of massage strokes </li></ul><ul><li>Massage strokes vary by </li></ul><ul><ul><li>Applying more or less pressure </li></ul></ul><ul><ul><li>Using different parts of the hand </li></ul></ul><ul><ul><li>Changing direction of the stroke </li></ul></ul><ul><ul><li>Changing rhythm and speed of application </li></ul></ul>
  5. 5. Effleurage <ul><li>Gliding manipulation performed with light centripetal pressure that deforms subcutaneous tissue down to the deep fascia </li></ul><ul><ul><li>Directed toward the heart or proximally </li></ul></ul>
  6. 6. Effleurage (cont.) <ul><li>Keys to applying effleurage </li></ul><ul><ul><li>Apply rhythmic stroking on the skin. </li></ul></ul><ul><ul><li>Can be either light or deep </li></ul></ul><ul><ul><li>Light massage promotes relaxation and sensory reflexes. </li></ul></ul><ul><ul><li>Deep massage promotes the mechanical effects. </li></ul></ul><ul><ul><ul><li>Increases b lood and lymphatic circulation </li></ul></ul></ul>
  7. 7. Effleurage (cont.) <ul><ul><li>Deep stroking </li></ul></ul><ul><ul><ul><li>Follow the course of veins and lymph vessels. </li></ul></ul></ul><ul><ul><li>Superficial stroking </li></ul></ul><ul><ul><ul><li>Follow the contour of body or the underlying tissue. </li></ul></ul></ul><ul><ul><li>Use palms of both hands in a deliberate, rhythmic fashion. </li></ul></ul>
  8. 8. Effleurage (cont.) <ul><li>Keep one hand in contact with skin at all times by stroking in one direction with both hands and return to beginning with light finger tip contact or stagger hands, making contact with the second before lifting the first from the body. </li></ul><ul><li>Begin and end massage with light effleurage. </li></ul>
  9. 9. Pétrissage <ul><li>From the French p é trir, “to knead” </li></ul><ul><li>Group of related techniques that repetitively compress, (squeeze) shear, (wring), and release muscle tissue with varying amounts of drag </li></ul><ul><ul><li>Lift and glide </li></ul></ul>
  10. 10. Pétrissage (cont.) <ul><li>Keys to applying pétrissage: </li></ul><ul><ul><li>Lift and knead the tissue (skin, subcutaneous, muscle). </li></ul></ul><ul><ul><li>Lift tissue between thumb and fingers or fingers and palm </li></ul></ul><ul><ul><li>Then gently roll and knead tissue in hand. </li></ul></ul>
  11. 11. Pétrissage (cont.) <ul><ul><li>Gently wring muscle between two hands as if you were wringing water out of a dishrag. </li></ul></ul><ul><ul><li>Often performed without lubricant or lotion </li></ul></ul><ul><ul><li>Stretches and separates muscle fiber, fascia, and scar tissue </li></ul></ul>
  12. 12. Friction Massage <ul><li>Repetitive, specific, nongliding, shearing technique that produces movement between the fibers of dense connective tissue </li></ul><ul><ul><li>Increasing tissue extensibility </li></ul></ul><ul><ul><li>Promotes ordered alignment of collagen within the tissues </li></ul></ul>
  13. 13. Friction Massage (cont.) <ul><li>Rationale for applying friction massage is to mobilize muscle and separate adhesions in muscle, tendons, or scar tissue that restrict movement and cause pain. </li></ul><ul><li>Sometimes chronic inflammation occurs because an injury does not go through the normal stages of inflammation and healing. </li></ul>
  14. 14. Friction Massage (cont.) <ul><li>The purpose is to try and increase inflammation (jump-start it) to a point at which the inflammatory process will run its normal course and the injury can progress. </li></ul><ul><li>Keys to applying friction massage </li></ul><ul><ul><li>Can be applied in a circular or transverse fashion </li></ul></ul><ul><ul><li>If circular, thumbs work in circular motion. </li></ul></ul>
  15. 15. Friction Massage (cont.) <ul><ul><li>If transverse, thumbs stroke tissue from opposite directions. </li></ul></ul><ul><ul><li>Should be applied across fibers when treating a ligament or tendon </li></ul></ul><ul><ul><li>When treating scar tissue in which the collagen has less regular organization, directions may be alternated or applied in a circular motion. </li></ul></ul>
  16. 16. Friction Massage (cont.) <ul><li>Can use elbow on large muscles </li></ul><ul><li>Place muscle in relaxed position. </li></ul><ul><li>Apply sufficient pressure to reach deep into tissue </li></ul><ul><li>Do not use on acute injury </li></ul><ul><li>Usually is painful </li></ul><ul><li>May be followed by stretching to increase ROM </li></ul>
  17. 17. Percussion <ul><li>Tapotement </li></ul><ul><ul><li>Repeated rhythmical light striking of the skin </li></ul></ul><ul><li>Techniques include </li></ul><ul><ul><li>Gentle tapping </li></ul></ul><ul><ul><li>Pounding </li></ul></ul><ul><ul><li>Cupping </li></ul></ul><ul><ul><li>Hacking </li></ul></ul><ul><ul><li>Slapping the skin </li></ul></ul>
  18. 18. Percussion (cont.) <ul><li>Two main uses </li></ul><ul><ul><li>For respiratory ailments to promote phlegm mobilization </li></ul></ul><ul><ul><li>Stimulation for precompetition preparation </li></ul></ul>
  19. 19. Percussion (cont.) <ul><li>Keys to applying percussion massage </li></ul><ul><ul><li>Hacking is done with the ulnar side of hand, with wrist and fingers limp </li></ul></ul><ul><ul><ul><li>Karate chop </li></ul></ul></ul>
  20. 20. Percussion (cont.) <ul><ul><li>During cupping, only the rim of the hand should come in contact with the body </li></ul></ul>
  21. 21. Percussion (cont.) <ul><ul><li>Raindrops </li></ul></ul><ul><ul><li>Variation to promote relaxation and desensitization of irritated nerve endings </li></ul></ul><ul><ul><li>Applied by lightly touching the skin with fingers in an alternating manner </li></ul></ul><ul><ul><ul><li>Typing </li></ul></ul></ul>
  22. 22. Vibration <ul><li>Shaking </li></ul><ul><ul><li>Repetitively moving soft tissue back and forth over the underlying bone with minimal joint motion </li></ul></ul>
  23. 23. Vibration (cont.) <ul><li>Principal uses </li></ul><ul><ul><li>Relaxation of skeletal muscle </li></ul></ul><ul><ul><li>As a stimulus for precompetition and intercompetition owing to its effects of systemic arousal and enhanced awareness </li></ul></ul>
  24. 24. Vibration (cont.) <ul><li>Keys to applying vibration massage </li></ul><ul><ul><li>Apply moderate to rapid shaking strokes to the skin. </li></ul></ul><ul><ul><ul><li>Rapid for precompetition </li></ul></ul></ul><ul><ul><ul><li>Moderate for postcompetition </li></ul></ul></ul><ul><ul><li>Can be applied with the hands or with a machine </li></ul></ul>
  25. 25. Myofascial Release <ul><li>Combination of traction with varying amounts of stretch </li></ul><ul><li>Used to produce a moderate sustained force on the muscle and its fascia </li></ul><ul><li>Currently, “Active Release Technique” is popular among Chiropractors </li></ul>
  26. 26. Myofascial Release (cont.) <ul><li>Goal is to produce viscoelastic lengthening (creep) and plastic deformation of the fascia. </li></ul><ul><li>Indicated to </li></ul><ul><ul><li>Lengthen fascial layers </li></ul></ul><ul><ul><li>Restore mobility between fascial layers </li></ul></ul><ul><ul><li>Decrease the effects of adhesions </li></ul></ul>
  27. 27. Myofascial Release (cont.) <ul><li>Indicated for conditions in which chronic fascial shortening results in limited joint ROM and ease of movement </li></ul>
  28. 28. Massage Lubricants <ul><li>Used to decrease friction and control the amount of glide and drag that occurs between the clinician’s moving hands and the client’s skin </li></ul><ul><ul><li>Aids some techniques (where gliding is required) </li></ul></ul><ul><ul><li>Hinders some techniques (friction) </li></ul></ul>
  29. 29. Massage Lubricants (cont.) <ul><li>Should be hypoallergenic </li></ul><ul><li>To Avoid risk of contamination, dispense from: </li></ul><ul><ul><li>Squeeze bottle </li></ul></ul><ul><ul><li>Pump </li></ul></ul><ul><ul><li>Shaker </li></ul></ul><ul><li>Four main types </li></ul><ul><ul><li>Lotions </li></ul></ul><ul><ul><li>Oils </li></ul></ul><ul><ul><li>Creams </li></ul></ul><ul><ul><li>Powders </li></ul></ul>
  30. 30. Lotions <ul><li>Most commonly used in sports medicine </li></ul><ul><ul><li>Examples include flexall, biofreeze, & icy-hot </li></ul></ul><ul><li>Opaque liquid suspensions of particles in either oil or water </li></ul><ul><li>Lose their ability to lubricate fairly rapidly. </li></ul><ul><li>As we know from the ultrasound chapter, some lotions claim to be conductive. </li></ul>
  31. 31. Lotions (cont.) <ul><li>Rapid absorption </li></ul><ul><ul><li>However can be advantageous when preparing for deeper or more vigorous strokes for which little or no lotion is wanted </li></ul></ul><ul><li>Clean up fairly easy with soap and water </li></ul>
  32. 32. Oils <ul><li>Aren’t used in sports medicine as much as lotions </li></ul><ul><li>Lubricant of choice among massage therapists </li></ul>
  33. 33. Oils (cont.) <ul><li>Mineral oil popular </li></ul><ul><li>Any high-quality vegetable oil can be used </li></ul><ul><ul><li>Sunflower </li></ul></ul><ul><ul><li>Olive </li></ul></ul><ul><ul><li>Almond </li></ul></ul><ul><ul><li>Safflower </li></ul></ul><ul><ul><li>Coconut </li></ul></ul><ul><ul><li>Jojoba </li></ul></ul>
  34. 34. Oils (cont.) <ul><li>Advantages </li></ul><ul><ul><li>Doesn’t absorb into the skin very fast </li></ul></ul><ul><ul><li>Clinician doesn’t have to keep adding more </li></ul></ul><ul><li>Disadvantages </li></ul><ul><ul><li>Messy and leave a stain </li></ul></ul><ul><ul><li>Cover clothing (clinician’s and patient’s) in the direct vicinity of the treatment </li></ul></ul><ul><ul><li>Patient will need to shower after the treatment or the area must be wiped off with disposable towels </li></ul></ul>
  35. 35. Sports Creams <ul><li>Thicker suspensions that fall midway between oils and lotions in their absorption rate </li></ul><ul><li>Some contain more oil to promote gliding techniques. </li></ul><ul><li>Other creams contain sticky substances, such as lanolin or beeswax, to reduce glide for tissue-release techniques. </li></ul>
  36. 36. Sports Creams (cont.) <ul><li>Many claim to be “deep acting”—rarely proven to be an accurate claim, similar to superficial heat sources. </li></ul><ul><li>Active ingredients often include </li></ul><ul><ul><li>Menthol </li></ul></ul><ul><ul><li>Capsaicin </li></ul></ul><ul><ul><li>Aloe vera </li></ul></ul>
  37. 37. Powders <ul><li>Used when people refuse lotions, creams, or oils </li></ul><ul><li>Unscented baby powder or cornstarch is commonly used. </li></ul><ul><li>Weaknesses </li></ul><ul><ul><li>Not very lubricative </li></ul></ul><ul><ul><li>Requires a lot of clean up </li></ul></ul>
  38. 38. Massage, Defined <ul><li>A. Definition </li></ul><ul><ul><li>Systematic manual manipulation of the body’s tissues </li></ul></ul><ul><ul><li>One of the oldest and most widespread healing techniques </li></ul></ul><ul><ul><li>Most cultures use it, so there are many variations. </li></ul></ul><ul><ul><li>A skill based technique; licensed in many states </li></ul></ul>
  39. 39. Massage Effects <ul><li>B. Effects </li></ul><ul><ul><li>Large placebo effect </li></ul></ul><ul><ul><li>Depends on type, pressure, and speed of stroke </li></ul></ul><ul><ul><li>Difficult to differentiate between physiological and psychological effects </li></ul></ul><ul><ul><li>Invigorate athlete: fast, deep strokes </li></ul></ul><ul><ul><li>Promote relaxation: light slow stroking </li></ul></ul><ul><ul><li>Promote blood flow: deep, vigorous, or friction </li></ul></ul><ul><ul><li>Promotes lymph flow </li></ul></ul>
  40. 40. Massage Effects, (cont.) <ul><ul><ul><li>8. Decrease pain </li></ul></ul></ul><ul><ul><ul><li>a. Mechanical: interrupting muscular spasm and reducing edema </li></ul></ul></ul><ul><ul><ul><li>b. Chemical: increased blood and lymph flow to rid tissue of cellular wastes </li></ul></ul></ul><ul><ul><ul><li>c. General: activate cutaneous receptors to gate pain </li></ul></ul></ul><ul><ul><ul><li>d. Doesn’t promote endorphin release </li></ul></ul></ul><ul><ul><ul><li>9. Petrissage decreases neuromuscular excitability but only in muscles massaged. </li></ul></ul></ul><ul><ul><ul><li>10. Increased hamstring flexibility after routine of deep effleurage, circular friction, and transverse friction to hamstrings </li></ul></ul></ul>
  41. 41. Massage Effects, (cont.) <ul><ul><li>11. No effect on stride frequency or length in </li></ul></ul><ul><ul><li>sprinters </li></ul></ul><ul><ul><li>12. Muscular fatigue unaffected by massage </li></ul></ul><ul><ul><li>between bouts (sprinters legs and pitchers </li></ul></ul><ul><ul><li>arms) </li></ul></ul><ul><ul><li>13. Recovery after exercise unaffected by </li></ul></ul><ul><ul><li>massage </li></ul></ul><ul><ul><li>14. No change in cardiac output, blood </li></ul></ul><ul><ul><li>pressure, or lactic acid accumulation during </li></ul></ul><ul><ul><li>submaximal treadmill running after massage </li></ul></ul>
  42. 42. Advantages of Massage <ul><li>C. Advantages </li></ul><ul><ul><ul><li>There is something healing about laying on of </li></ul></ul></ul><ul><ul><ul><li>hands. </li></ul></ul></ul><ul><ul><ul><li>Can be very relaxing and soothing </li></ul></ul></ul><ul><ul><ul><li>Requires no special equipment </li></ul></ul></ul><ul><ul><ul><li>Can become skilled in using it; extensive background helps, but is not required. </li></ul></ul></ul><ul><ul><ul><ul><li>a. Can instruct individuals, family, and friends to do their </li></ul></ul></ul></ul><ul><ul><ul><ul><li>own massage. </li></ul></ul></ul></ul>
  43. 43. Disadvantages of Massage <ul><li>D. Disadvantages </li></ul><ul><ul><ul><li>Time consuming </li></ul></ul></ul><ul><ul><ul><li>Lotions, oils, and powders can get messy. </li></ul></ul></ul><ul><ul><ul><li>Easy for therapist to overuse hands. </li></ul></ul></ul>
  44. 44. Indications for Massage <ul><li>E. Indications </li></ul><ul><ul><li>Increase venous return </li></ul></ul><ul><ul><li>Break pain – spasm – pain cycle </li></ul></ul><ul><ul><li>Evoke systemic relaxation </li></ul></ul><ul><ul><li>Improve or stimulate local blood flow </li></ul></ul>
  45. 45. Massage Contraindications <ul><li>F. Contraindications </li></ul><ul><ul><ul><li>Acute sprains and strains: massage may… </li></ul></ul></ul><ul><ul><ul><ul><li>a. Increase the inflammatory response </li></ul></ul></ul></ul><ul><ul><ul><ul><li>b. Cause myositis ossificans </li></ul></ul></ul></ul><ul><ul><ul><li>Over skin with lesions or disease conditions </li></ul></ul></ul><ul><ul><ul><ul><li>a. May spread disease over the patient or to </li></ul></ul></ul></ul><ul><ul><ul><ul><li>massage therapist </li></ul></ul></ul></ul><ul><ul><ul><li>Sites where fractures have failed to heal </li></ul></ul></ul><ul><ul><ul><li>People who are hypersensitive to touch </li></ul></ul></ul>
  46. 46. Massage Precautions <ul><li>G. Precautions </li></ul><ul><li> 1. Pitting edema </li></ul><ul><li> 2. Hypertension </li></ul><ul><li>(why are these precautions?) </li></ul>
  47. 47. Setup: Therapeutic Massage <ul><ul><li>A. Make sure massage is proper modality for this situation. </li></ul></ul><ul><ul><li>Ensure a suitable environment, including </li></ul></ul><ul><ul><ul><li>Comfortable room temperature (68 – 72 ° F) </li></ul></ul></ul><ul><ul><ul><li>Upholstered table to protect pressure points and bony prominences (pelvic bones, ankles, head) </li></ul></ul></ul><ul><ul><ul><li>Relaxed atmosphere </li></ul></ul></ul>
  48. 48. Setup: Therapeutic Massage (cont.) <ul><li>C. Position patient </li></ul><ul><ul><li>Both patient and clinician should be comfortable; minimize overuse with good ergonomic positioning </li></ul></ul><ul><ul><li>Place rolled up towel under body parts (for instance the ankle) to increase comfort. </li></ul></ul>
  49. 49. Setup: Therapeutic Massage (cont.) <ul><li>Make sure patient is properly draped with towels to ease apprehension about nudity ( If massage involves body parts where this may be a concern). </li></ul><ul><li>Determine the type of massage to give. </li></ul><ul><ul><li>1. What strokes to use and in what order </li></ul></ul><ul><ul><li>2. Determine use of lubricants. </li></ul></ul>
  50. 50. Parameters for Massage <ul><ul><li>There are no set procedures. </li></ul></ul><ul><ul><ul><li>Clinician designs application to meet individual’s needs. </li></ul></ul></ul><ul><ul><ul><li>Some Physical Therapists believe in no more than 6-8 min. per area of treatment, or other modalities should be used instead. </li></ul></ul></ul><ul><ul><li>During the treatment, seek feedback concerning patient’s response to treatment by periodically asking questions, such as </li></ul></ul><ul><ul><ul><li>How are you feeling? </li></ul></ul></ul><ul><ul><ul><li>Is it tender here? </li></ul></ul></ul><ul><ul><ul><li>Is this pressure OK? </li></ul></ul></ul>
  51. 51. Massage Postapplication & Maintenance <ul><ul><li>Clean up massage lubricant. </li></ul></ul><ul><ul><li>Make appointment for next treatment. </li></ul></ul><ul><ul><li>Instruct patient concerning activity level and self-treatment before next formal treatment. </li></ul></ul><ul><ul><li>Record treatment and any special responses to the treatment. </li></ul></ul><ul><ul><li>Keep hands free of calluses. </li></ul></ul>
  52. 52. Therapeutic Massage Resources <ul><li>The Trigger Point Therapy Workbook , 2 nd ed. (2004) by Davies and Davies. MSRP $19.95; find it on Amazon. </li></ul><ul><li> </li></ul><ul><li>Myofascial Pain and Dysfunction , 2 nd ed. (1999) by Simons, Travell, & Simons. 2 volumes. </li></ul><ul><li>Note: Therapeutic massage isn’t synonymous with manual therapy </li></ul><ul><li>(ex: joint mobilizations and manipulations) </li></ul>