Therapeutic massage

1. © 2005
Therapeutic Massage

2. © 2005
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

5. © 2005
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

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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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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

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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

14. © 2005
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

15. © 2005
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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Indications
• Increase blood flow
• Facilitate healing
• Increase range of motion
• Remove edema
• Alleviate muscle cramps
• Stretch scar tissue/adhesions
• Decrease pain

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

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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

21. © 2005
Edema Reduction Massage

22. © 2005
Preparation
• Elevate the body area
• Apply massage lubricant to the skin
• Clinician is positioned distal to the extremity

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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

24. © 2005
Termination
• Remove medium
• If appropriate:
– Active range of motion exercises
– Compression wrap
• Encourage patient to drink water to assist in
flushing metabolic waste

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