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Massage therapy

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Massage therapy

  1. 1. Massage TherapyMassage Therapy
  2. 2. History of MassageHistory of Massage  Natural reaction to when the body hurts is to rub itNatural reaction to when the body hurts is to rub it  Dates back to at least the ancient OlympicsDates back to at least the ancient Olympics  In Europe in the Middle Ages, the Church of Rome &In Europe in the Middle Ages, the Church of Rome & its religious teachings discouraged massage as aits religious teachings discouraged massage as a healing practicehealing practice  Massage is derived from 2 sourcesMassage is derived from 2 sources  Arabic verbArabic verb massmass “to touch”“to touch”  Greek wordGreek word masseinmassein “to knead”“to knead”  Egyptians, Romans, Japanese, Persians, & ChineseEgyptians, Romans, Japanese, Persians, & Chinese were known to practice massage therapywere known to practice massage therapy
  3. 3. History of MassageHistory of Massage  Sweden – early 19Sweden – early 19thth century, Peter Lingcentury, Peter Ling (acknowledged(acknowledged founder of curative gymnastics)founder of curative gymnastics) – appears to be founder of– appears to be founder of modern day massage techniques, incorporated withmodern day massage techniques, incorporated with French massage techniquesFrench massage techniques  Techniques have changed dramatically in the past 50Techniques have changed dramatically in the past 50 yearsyears  Based on research by Albert Hoffa (1859-1907), JamesBased on research by Albert Hoffa (1859-1907), James Mennell 1880-1957), & Gertrude Beard (1887-1971).Mennell 1880-1957), & Gertrude Beard (1887-1971).  Scientific basis to massage was addedScientific basis to massage was added  Late 1980’s, Amer. Massage Therapy Association wasLate 1980’s, Amer. Massage Therapy Association was organized (1992 – Nat’l Cert. Exam. For Therapeuticorganized (1992 – Nat’l Cert. Exam. For Therapeutic Massage & Bodywork was formed)Massage & Bodywork was formed)
  4. 4. What is Massage Therapy?What is Massage Therapy?  Mechanical modalityMechanical modality  Used to manipulate the body’s tissueUsed to manipulate the body’s tissue  Effective in promoting local & systemic relaxation,Effective in promoting local & systemic relaxation, increasing local b. flow, breaking down adhesions, &increasing local b. flow, breaking down adhesions, & encouraging venous returnencouraging venous return  Act of rubbing, kneading, or stroking the superficialAct of rubbing, kneading, or stroking the superficial parts of the body with the hand or an instrument forparts of the body with the hand or an instrument for the purpose of modifying nutrition, restoring powerthe purpose of modifying nutrition, restoring power of movement or breaking up adhesionsof movement or breaking up adhesions  Time-consumingTime-consuming
  5. 5. Treatment Considerations &Treatment Considerations & GuidelinesGuidelines  Need to know underlying pathologyNeed to know underlying pathology  Need to know basic massage principles (must haveNeed to know basic massage principles (must have manual dexterity, coordination, & concentration). Mustmanual dexterity, coordination, & concentration). Must also exhibit patience & courteousness.also exhibit patience & courteousness.  Hands must be clean, warm, dry & soft. Nails must beHands must be clean, warm, dry & soft. Nails must be short and smooth. Hands should be warm.short and smooth. Hands should be warm.  Avoid constant hyperextension or hyperflexion of anyAvoid constant hyperextension or hyperflexion of any joints which may lead to hypermobility.joints which may lead to hypermobility.  Must obtain correct positioning that will allow forMust obtain correct positioning that will allow for relaxation, prevent fatigue & permit free movement ofrelaxation, prevent fatigue & permit free movement of arms, hands, & body.arms, hands, & body.
  6. 6. Treatment Considerations &Treatment Considerations & GuidelinesGuidelines  Must obtain good posture to prevent fatigue &Must obtain good posture to prevent fatigue & backache.backache.  Weight should be evenly distributed on bothWeight should be evenly distributed on both feet.feet.  You must be able to fit your hands to theYou must be able to fit your hands to the contour of the area being treated.contour of the area being treated.  A good position is required to allow for correctA good position is required to allow for correct application of pressure and rhythmic strokesapplication of pressure and rhythmic strokes during the procedure.during the procedure.
  7. 7. Points for ConsiderationPoints for Consideration  Pressure regulation should be determined byPressure regulation should be determined by the type & amount of tissue present. Also,the type & amount of tissue present. Also, pressure is governed by the condition & whichpressure is governed by the condition & which tissues are affected.tissues are affected.  Each stroke must have equal pressure & timeEach stroke must have equal pressure & time (rhythm present).(rhythm present).  Duration depends on pathology, size of area,Duration depends on pathology, size of area, speed of motion, age, size, & condition ofspeed of motion, age, size, & condition of athlete. Also, massage may not be warrantedathlete. Also, massage may not be warranted on a daily basis (e.g. friction massage).on a daily basis (e.g. friction massage).  Some areas may take 30 minutes.Some areas may take 30 minutes.
  8. 8. Points for ConsiderationPoints for Consideration  If swelling is present in an extremity,If swelling is present in an extremity, treatment should begin proximally.treatment should begin proximally.  ““Uncorking the bottle”, “uncorking effect”Uncorking the bottle”, “uncorking effect”  Massage should never be painful, exceptMassage should never be painful, except possibly for friction massage. It should notpossibly for friction massage. It should not cause ecchymosis.cause ecchymosis.  Direction of forces should be applied in theDirection of forces should be applied in the direction of the muscle fibers.direction of the muscle fibers.  Each session should begin & end withEach session should begin & end with effleurage.effleurage.
  9. 9. Points for ConsiderationPoints for Consideration  Make sure the patient is warm and in a comfortable,Make sure the patient is warm and in a comfortable, relaxed position. Also, make sure the patient isrelaxed position. Also, make sure the patient is properly draped.properly draped.  The body part may be elevated if necessary.The body part may be elevated if necessary.  Massage should begin with superficial stroking.Massage should begin with superficial stroking.  Each stroke should start at the joint or just below theEach stroke should start at the joint or just below the joint (unless contraindicated) and finish above thejoint (unless contraindicated) and finish above the joint so that strokes overlap.joint so that strokes overlap.  Pressure should be in line with venous flow.Pressure should be in line with venous flow.  Bony prominences & painful joints should be avoidedBony prominences & painful joints should be avoided if possible.if possible.
  10. 10. Massage MediaMassage Media  Used to decrease friction between theUsed to decrease friction between the patient’s skin and the clinician’s handpatient’s skin and the clinician’s hand  Massage can be given without any mediumMassage can be given without any medium being usedbeing used  Lotions, peanut oil, powder, analgesicLotions, peanut oil, powder, analgesic balmsbalms  More medium should be used onMore medium should be used on hairy areashairy areas  During petrissage – lubricantsDuring petrissage – lubricants interfere with the kneading & liftinginterfere with the kneading & lifting  During friction massage –During friction massage – lubricants may interfere withlubricants may interfere with the certain results you want tothe certain results you want to obtainobtain
  11. 11. Massage StrokesMassage Strokes  EffleurageEffleurage  PetrissagePetrissage  Friction (circular, transverse)Friction (circular, transverse)  TapotementTapotement  VibrationVibration  Myofascial release techniquesMyofascial release techniques  Various other forms – some may combineVarious other forms – some may combine strokesstrokes
  12. 12. Physiological Effects of MassagePhysiological Effects of Massage TherapyTherapy  Depending on the amount of pressure applied & theDepending on the amount of pressure applied & the speed of the stroke, many results can occurspeed of the stroke, many results can occur  Light, slow stroking – evokes systemic relaxationLight, slow stroking – evokes systemic relaxation  Fast, deep strokes increase blood flow to the areaFast, deep strokes increase blood flow to the area  Cardiovascular changes –Cardiovascular changes – deep friction or vigorousdeep friction or vigorous massage was thought to produce vascular changesmassage was thought to produce vascular changes  Research failed to support those theoriesResearch failed to support those theories  No increase in cardiac output, b.p., or increased arterial b.No increase in cardiac output, b.p., or increased arterial b. flow were revealedflow were revealed  Massage can produce decreased heart rate, breathing rate,Massage can produce decreased heart rate, breathing rate, & b.p. if the purpose is for inducing system relaxation& b.p. if the purpose is for inducing system relaxation
  13. 13. Physiological EffectsPhysiological Effects  PetrissagePetrissage has been shown tohas been shown to decreasedecrease neuromuscular excitabilityneuromuscular excitability, but only during the, but only during the massage (effects confined to muscle beingmassage (effects confined to muscle being massaged)massaged)  Deep effleurageDeep effleurage, circular & transverse friction, circular & transverse friction has shown tohas shown to improve flexibilityimprove flexibility  Massage isMassage is less effective in decreasingless effective in decreasing muscular recovery timemuscular recovery time, but may be effective, but may be effective (2 hrs post) in reducing amount of DOMS(2 hrs post) in reducing amount of DOMS  Little reduction in m. fatigue when performingLittle reduction in m. fatigue when performing between exercise (pitcher, sprinter)between exercise (pitcher, sprinter)
  14. 14. Physiological EffectsPhysiological Effects  Edema reduction – when performed properly itEdema reduction – when performed properly it cancan increase venous & lymphatic flowincrease venous & lymphatic flow  Reduces painReduces pain  By decreasing pressure from swelling, mechanicalBy decreasing pressure from swelling, mechanical pain can be reducedpain can be reduced  By interrupting m. spasm, mechanical pain can beBy interrupting m. spasm, mechanical pain can be reducedreduced  By reducing edema, mechanical pain can be reducedBy reducing edema, mechanical pain can be reduced  By increasing b. flow & encouraging waste removal,By increasing b. flow & encouraging waste removal, chemical pain can be reducedchemical pain can be reduced  Activates sensory nerves – inhibits painActivates sensory nerves – inhibits pain
  15. 15. Mechanical EffectsMechanical Effects  Techniques that stretch a muscle, elongateTechniques that stretch a muscle, elongate fascia, or mobilize soft-tissue adhesions orfascia, or mobilize soft-tissue adhesions or restrictions are all mechanical techniquesrestrictions are all mechanical techniques  Mechanical effects are always accompanied byMechanical effects are always accompanied by some reflex effectssome reflex effects  As mechanical stimulus becomes more effective,As mechanical stimulus becomes more effective, reflex stimulus becomes less effectivereflex stimulus becomes less effective  Muscle – massage is done either forMuscle – massage is done either for mechanical stretching or to relieve painmechanical stretching or to relieve pain associated with trigger pointsassociated with trigger points
  16. 16. Mechanical EffectsMechanical Effects  Skin – massage has been shown to increaseSkin – massage has been shown to increase skin temperature, increase sweating &skin temperature, increase sweating & decrease resistance to electrical currentdecrease resistance to electrical current  It has been shown to toughen yet soften theIt has been shown to toughen yet soften the skinskin  Acts directly on the surface of the skin toActs directly on the surface of the skin to remove dead cellsremove dead cells  Stretches & breaks down fibrous tissueStretches & breaks down fibrous tissue
  17. 17. Psychological EffectsPsychological Effects  One-on-One treatmentOne-on-One treatment  Reduces patient anxiety, depression, & mentalReduces patient anxiety, depression, & mental stressstress  Patient compliance is increasedPatient compliance is increased  Patient gains confidence in clinicianPatient gains confidence in clinician
  18. 18. EffleurageEffleurage  Stroking of the skinStroking of the skin  Performed with palm of handPerformed with palm of hand  Stimulates deep tissuesStimulates deep tissues  Performed with fingertipsPerformed with fingertips  Stimulates sensory nervesStimulates sensory nerves  Superficial, rhythmic stroking:Superficial, rhythmic stroking:  Contours the body or relates to direction ofContours the body or relates to direction of underlying musclesunderlying muscles  Deep stroking:Deep stroking:  Follows course of veins & lymph vesselsFollows course of veins & lymph vessels
  19. 19. EffleurageEffleurage  May be performed slowly for relaxation orMay be performed slowly for relaxation or rapidly to encourage blood flow & stimulaterapidly to encourage blood flow & stimulate the tissuesthe tissues  Performed in rhythmic mannerPerformed in rhythmic manner  One hand should always be in contact w/ skinOne hand should always be in contact w/ skin  Light effleurage is performed at beginning &Light effleurage is performed at beginning & end of massage or may be used betweenend of massage or may be used between petrissage strokespetrissage strokes  At beginning – relaxes patient & indicates area toAt beginning – relaxes patient & indicates area to be treatedbe treated  At end – calms down any irritated areasAt end – calms down any irritated areas
  20. 20. PetrissagePetrissage  Lifting & kneading of skin,Lifting & kneading of skin, subcutaneous tissue, & musclessubcutaneous tissue, & muscles  Performed with fingers or handPerformed with fingers or hand  Skin is gently lifted betweenSkin is gently lifted between thumb & fingers or fingers &thumb & fingers or fingers & palm & gently rolled & kneadedpalm & gently rolled & kneaded in the handin the hand  Often performed without lotionOften performed without lotion  Frees adhesions by stretching &Frees adhesions by stretching & separating muscle fiber, fascia,separating muscle fiber, fascia, & scar tissue while assisting& scar tissue while assisting with venous return & milkingwith venous return & milking out waste productsout waste products
  21. 21. FrictionFriction  Goal is to mobilize muscle & separate adhesionsGoal is to mobilize muscle & separate adhesions that restrict movement & cause painthat restrict movement & cause pain  Facilitates local blood profusionFacilitates local blood profusion  Not necessarily a “pleasing” treatmentNot necessarily a “pleasing” treatment  Circular:Circular:  Applied with thumbs working in circular motionApplied with thumbs working in circular motion  Effective in treating muscle spasm & trigger pts.Effective in treating muscle spasm & trigger pts.
  22. 22. FrictionFriction  Transverse:Transverse:  Applied with thumbs or fingertips stroking theApplied with thumbs or fingertips stroking the tissue from opposite directionstissue from opposite directions  Can use elbow, end of rolling pin, etc. for largerCan use elbow, end of rolling pin, etc. for larger areasareas  Reaches deep tissuesReaches deep tissues  Begin lightly and then move to firmer strokesBegin lightly and then move to firmer strokes  Muscle should be placed in relaxed positionMuscle should be placed in relaxed position  Should be avoided in acute conditionsShould be avoided in acute conditions  Effective in tendonitis or other joint adhesionsEffective in tendonitis or other joint adhesions
  23. 23. TapotementTapotement  Gentle tapping or pounding of the skinGentle tapping or pounding of the skin  Most common form uses ulnar side of wrist toMost common form uses ulnar side of wrist to contact skin “karate chop”contact skin “karate chop”  Wrist & fingers are usually limp, alternateWrist & fingers are usually limp, alternate method “cups” the handmethod “cups” the hand  Promotes relaxation & densitization of irritatedPromotes relaxation & densitization of irritated nerve endingsnerve endings
  24. 24. VibrationVibration  Rapid shaking of the tissuesRapid shaking of the tissues  Soothes peripheral nervesSoothes peripheral nerves  A mechanical device can be usedA mechanical device can be used
  25. 25. MyofascialMyofascial ReleaseRelease  Involves effleurage, petrissage & friction massageInvolves effleurage, petrissage & friction massage strokes with stretching of muscles & fasciastrokes with stretching of muscles & fascia  Tries to obtain relaxation of tense and/or adheredTries to obtain relaxation of tense and/or adhered tissues (myo – muscle; fascia – band; ease the tensiontissues (myo – muscle; fascia – band; ease the tension of fibrous CT bands)of fibrous CT bands)  No structured patternNo structured pattern  Involves pulling of tissues in opposite directions,Involves pulling of tissues in opposite directions, stabilizing the proximal/superior position w/ one handstabilizing the proximal/superior position w/ one hand while applying a stretch w/ opposite hand, or usingwhile applying a stretch w/ opposite hand, or using the patient’s body weight to stabilize the extremitythe patient’s body weight to stabilize the extremity while a longitudinal stress is appliedwhile a longitudinal stress is applied  Can involve more than one clinicianCan involve more than one clinician
  26. 26. Myofascial ReleaseMyofascial Release  Purpose is to relieve soft tissue from abnormalPurpose is to relieve soft tissue from abnormal grip of tight fasciagrip of tight fascia  May also be known as soft-tissue mobilizationMay also be known as soft-tissue mobilization  Treatment is based on localizing the restrictionTreatment is based on localizing the restriction & moving into the direction of the restriction& moving into the direction of the restriction  Very subjective & relies on experience ofVery subjective & relies on experience of clinicianclinician  Recommended to treat at least 3 x per weekRecommended to treat at least 3 x per week
  27. 27. AcupressureAcupressure  Acupressure – based on Chinese art of AcupunctureAcupressure – based on Chinese art of Acupuncture  The Chinese make no distinction between arteries,The Chinese make no distinction between arteries, veins, or nerves when explaining function of the body.veins, or nerves when explaining function of the body.  Concentrate on the system of forces that regulate all bodilyConcentrate on the system of forces that regulate all bodily functions.functions.  Qi (pronounced “che” exists in everyone & controls allQi (pronounced “che” exists in everyone & controls all aspects of life)aspects of life)  Qi is governed by two opposing forces, Yang (positive) &Qi is governed by two opposing forces, Yang (positive) & Yin (negative) forces. Disease results from some imbalanceYin (negative) forces. Disease results from some imbalance between these two forces.between these two forces.  Yin & Yang pass flow through passageways/lines in the bodyYin & Yang pass flow through passageways/lines in the body called “jing” (Chinese) or “meridians” (West).called “jing” (Chinese) or “meridians” (West).
  28. 28. AcupressureAcupressure  12 meridians in the body12 meridians in the body named according to the partnamed according to the part of the body with which theyof the body with which they are associated. Theare associated. The meridians on one side of themeridians on one side of the body are duplicated on thebody are duplicated on the other side; however, twoother side; however, two additional meridians existadditional meridians exist that can’t be paired.that can’t be paired.  *not paired*not paired  Lung (L)Lung (L)  Large Intestine (LI)Large Intestine (LI)  Stomach (ST)Stomach (ST)  Spleen (SP)Spleen (SP)  Heart (H)Heart (H)  Small Intestine (SI)Small Intestine (SI)  Urinary bladder (UB)Urinary bladder (UB)  Kidney (K)Kidney (K)  Pericardium (P)Pericardium (P)  Triple warmet (TW)Triple warmet (TW)  Gall bladder (GB)Gall bladder (GB)  Liver (LIV)Liver (LIV)  Governing vessel (VB)*Governing vessel (VB)*  Conception vessel (CV)*Conception vessel (CV)*
  29. 29. AcupressureAcupressure  Along the meridians lie the acupuncture pointsAlong the meridians lie the acupuncture points  Whenever there is pain or illness, certain points onWhenever there is pain or illness, certain points on the surface of the body become tenderthe surface of the body become tender  When pain is eliminated, these tender spotsWhen pain is eliminated, these tender spots disappeardisappear  According to acupuncture theory, stimulation ofAccording to acupuncture theory, stimulation of specific points through needling can reducespecific points through needling can reduce pain in areas associated with a particular pointpain in areas associated with a particular point  Thousands of points have been identifiedThousands of points have been identified
  30. 30. AcupressureAcupressure  Electrical resistance of the skin at certainElectrical resistance of the skin at certain points corresponding to the acupuncture pointspoints corresponding to the acupuncture points is lower than that of surrounding skin,is lower than that of surrounding skin, especially when a disease state is present.especially when a disease state is present.  Russian research has shown evidence of skinRussian research has shown evidence of skin temperature difference at these points.temperature difference at these points.
  31. 31. Myofascial Trigger PointsMyofascial Trigger Points  Trigger points are the counterpart ofTrigger points are the counterpart of acupuncture pointsacupuncture points  May be found in muscle, tendons, myofascia,May be found in muscle, tendons, myofascia, ligaments & capsules surrounding joints, inligaments & capsules surrounding joints, in periosteum, & in the skinperiosteum, & in the skin  May activate & become painful due to traumaMay activate & become painful due to trauma  Stimulation of these points have resulted inStimulation of these points have resulted in pain reliefpain relief
  32. 32. What to do….What to do….  Location of points: Use an ohmmeter to differentiate theLocation of points: Use an ohmmeter to differentiate the electrical impedance of areas ORelectrical impedance of areas OR palpate the area untilpalpate the area until either a small fibrous nodule or strip of tense muscleeither a small fibrous nodule or strip of tense muscle tissue that is tender to the touch is felt.tissue that is tender to the touch is felt.  Once located, massage is begun using the thumb, indexOnce located, massage is begun using the thumb, index or middle fingers or the elbow.or middle fingers or the elbow.  Perform small friction-like circular motions over thePerform small friction-like circular motions over the point.point.  Amount of pressure should be determined by patientAmount of pressure should be determined by patient tolerance, and may be intense and painful.tolerance, and may be intense and painful.  Treatment time – 1-5 minutes at a single point.Treatment time – 1-5 minutes at a single point.  Patient will report a dulling/numbing effect & willPatient will report a dulling/numbing effect & will report the pain diminishes.report the pain diminishes.
  33. 33. RolfingRolfing  May also see it is “structural integration”May also see it is “structural integration”  GoalGoal - to balance the body within a- to balance the body within a gravitational field through a techniquegravitational field through a technique involving manual soft-tissue manipulationinvolving manual soft-tissue manipulation  Improve balance, posture, flexibility, movementImprove balance, posture, flexibility, movement efficiencyefficiency  Basic principle of treatment is - if balancedBasic principle of treatment is - if balanced movement is essential at a particular joint, yetmovement is essential at a particular joint, yet nearby tissue is restrained, both the tissue & thenearby tissue is restrained, both the tissue & the joint will relocate to a position that accomplishes ajoint will relocate to a position that accomplishes a more appropriate equilibrium.more appropriate equilibrium.
  34. 34. RolfingRolfing  Standardized approach that is administered withoutStandardized approach that is administered without regard to symptoms or pathologiesregard to symptoms or pathologies  Technique involves 10 hour-long sessions, eachTechnique involves 10 hour-long sessions, each emphasizing some aspect of postureemphasizing some aspect of posture  10 sessions include:10 sessions include:  Respiration, balance under the body (legs/feet), sagittalRespiration, balance under the body (legs/feet), sagittal plane balance (lateral line from front to back), balance leftplane balance (lateral line from front to back), balance left to right (base of body to midline), pelvic balance (rectusto right (base of body to midline), pelvic balance (rectus abdominis & psoas), weight transfer from head to feet –abdominis & psoas), weight transfer from head to feet – sacrum, relationship of head to rest of body, upper ½ ofsacrum, relationship of head to rest of body, upper ½ of body to lower ½ of body relationship, balance throughoutbody to lower ½ of body relationship, balance throughout the systemthe system  Additional “tune-up” sessions may be requiredAdditional “tune-up” sessions may be required  Integrates structural with psychological approachIntegrates structural with psychological approach
  35. 35. ReferencesReferences  ImagesImages  http://www.google.comhttp://www.google.com

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