This presentation is apt for Physiotherapy students with basic knowledge about STM.

1. THERAPEUTIC
MASSAGE
(SOFT TISSUE
MANIPULATION)
Submitted by – Sakshi Upadhyay
MPT Sports

2. Definition
• Massage is therapeutic manipulation of the soft tissues
of the body used to achieve normalization of those
tissue.
• It can be defined also as an act of rubbing, kneading, or
stroking the superficial parts of the body for the
purpose of modifying nutrition, restoring power of
movement or breaking down adhesions.

3. 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 bursitis, tendonitis, muscle spasm

4. Purpose of Massage
Manipulates the body’s tissues to: –
Reduce muscle spasm
Promote relaxation
Improve blood flow
Increase venous drainage

5. Physiological Effects of Massage
The physiological effects of Massage
include:
Mechanical
Physiological
Psychological

6. 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.
• Muscle – massage is done either for mechanical stretching or to
relieve pain associated with trigger points.
• Skin massage increases skin temperature, increases
sweating & decrease resistance to electrical current.
• It also softens the skin.
• It removes dead cells present on the skin surface. It stretches &
breaks down fibrous tissues.

7. PHYSIOLOGICAL Effects
• Depending on the amount of pressure applied & the speed of
the stroke, many results can occur:
1. Light, slow strokes that evoke systemic relaxation
2. Fast, deep strokes that increase blood flow to the area.
• Different body systems are affected by massage.
• Physiological effects are :
i. Muscular System
ii. Skeletal System
iii. Circulatory System
iv. Nervous System

8. 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

9. Skeletal System
• Improves posture/body alignment
• Relieve stiff joints
• Decreases inflammation
• Restores range of motion
• Releases joint strain
• Releases restrictions in the fascia
• Improves the circulation and
nutrients of your joints

10. 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 RBC’s,
especially in cases of anemia
• Lower blood pressure
• Reduces heart rate (helps develop
a stronger heart)
• Elimination of metabolic waste

11. Nervous System
• Stimulates Nervous System
(boosting energy)
• Calms the Nervous System
(relaxing)
• Relieves restlessness and
insomnia
• Relieves pain due to pinched
nerves
• Decreases chronic pain
• Stimulates the release of
endorphins (the body's natural painkiller)

12. Psychological Effects
• 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

13. Classification of Massage
MASSAGE
Effleurage/
Stroking
Petrissage
Tapotement
/Percussion
Friction
Vibration
Shaking

14. Effleurage / Stroking
• It is unidirectional manipulation of soft tissues from distal to proximal
in the direction of the lymph drainage.
• Effleurage is used more than any other massage
technique.
• It usually initiates and ends each treatments.
“Any stroke that glide over the
skin is called as effleurage”
Types of Stroking:
1. Superficial Stroking or Superficial Effleurage
2. Deep Stroking or Deep Effleurage

15. Effect of effleurage
Superficial Stroking
•Performed either from Proximal to Distal or
Distal to Proximal
Accustoms the patient to your touch.
Assessment of the skin and tissues state
Improves sensory analgesia.
Slow stroking will relax and sedate, and
decreases muscle tone.
Faster strokes will stimulate superficial blood
flow accelerating lymph drainage.
Deep Stroking
Applied from distal to proximal only.
Assists lymphatic and venous return.
Assists interchange of tissue fluid.
Assists removal of waste product
Passively stretches muscle fibres.
Restores mobility at tissue interfaces.
Light strokes decrease muscle tone.
Deep strokes increase muscle tone.

16. Types of effleurage
• Knuckling - Clench the fist in
palmar flexion, gradually bring
the hand from flexion to extension.
• Bilateral - Both hands progressing
simultaneously on the either side.
• Single - Single hand used for the
stroke

17. PETRISSAGE
Petrissage
Kneading
Picking
Up
Wringing
Rolling
Shaking

18. Kneading
• It is circular manipulation performed so that the skin and subcutaneous tissues are
moved in a circular manner on the underlying structures.
• It is performed with palmar aspect of the whole hand, with palm only, with all fingers, or
with the pads of the thumb or fingers.
• Effects
• Stimulates venous and lymphatic flow.
• Increases mobility of fibrous tissues.
• Helps interchange of tissue fluids.
• Helps prepare soft tissue for exercise.
• Helps removal of waste products.
• Increases length and strength of
connective tissues.
• Restores mobility between tissue interfaces.

19. • Classification of Kneading
Grade 1: is sufficient to influence superficial vessels and compress
superficial tissues of underlying structures.
Grade 2: effects deeper tissue drainage and will compress deep tissues
of underlying structures.
Grade 3: is applied to superimposed or reinforced strokes. It may be
applied as strongly as can be tolerated by the patient without
producing tissue damage.

20. Picking up
• Compressing the tissues against
the underlying structures,
then 'picked up', lifted, squeezed
and released.
• The manipulation can be
single-handed in a C-shape ,
double-handed in alternate
C-shapes and V-shapes or
double-handed in a V-shape.

21. Wringing
• Compressing the tissues against
underlying structures, then one
hand pulls towards the you while
the other hand pushes away.
• Effects
Particularly good for separating
superficial and deep adherent tissues.
There are only two grades for wringing:
Grade 1 is usually applied to finger strokes only.
Grade 2 uses the whole hand

22. ROLLING
• The fingers pull the tissue towards
the thumbs and then the thumbs
squeeze and lift to push the tissue away.
• Types: skin rolling and muscle rolling
• Effects
• Mobilizes scar tissue.
• When performed slowly, it has
a stretch effect on the tissues
being manipulated.

23. Shaking
• Muscle or more superficial tissue
can be shaken from side to side
• Tips or whole hand are used
• Effects
• Produces a feeling of stimulation.
• Increases tissue mobility.
• Assists in breaking down tissue adhesions.
• Stimulates lymphatic and venous flow.
• Helps prepare soft tissues for stretch and exercise.

24. FRICTION
• It is a localized manipulation
applied at the injury point aiming
to give a stretching across the fibers
to separate them and restore mobility.
• Effects
• Restore tissue mobility.
• Stimulate local circulation.
• Aid the resolution of inflammation.
• Reduce pain as a counter-irritant effect.
• Stretch fibrous tissue.

25. • Types of Friction
1. Circular : Friction is applied in circular manner by the fingers. Rest of
hand should be out of the contact. This manipulation can be used over
ligaments and myofascial junctions.
2. Transverse: Friction is applied horizontally by the thumb or fingers. This
manipulation can be used over tendon, ligament, myofascial junctions
and muscles
Classification of Friction
Grade 1 does not apply to this technique as it is aimed at deeper structures.
Grade 2 is sufficient to affect deep tissue and cause compression.
Grade 3 applies to reinforced and most transverse frictions and may produce
pain before causing numbing.

26. PERCUSSION/TAPOTEMENT
Percussion
Hacking
Clapping
Beating
Pounding
Tapping
Vibration

27. Hacking
• Hold the hands so that the palms are parallel.
Strike the part with a series of soft, but brisk
blows, using the lateral borders of the middle,
ring and little finger. Use both hand alternatively
and strike rapidly with pronation and
supination at forearm.
• Effects
• Stimulates local circulation.
• Stimulates muscle tone.
• Gives a generalized feeling of stimulation.
• Provokes muscle and tendon reflexes.
• Light strokes affect superficial tissue.
• Deeper strokes aid the evacuation of secretion from the lungs.

28. • Classification of Hacking
Grade 1 uses only the medial borders of the fingers.
Grade 2 uses the medial borders of hands and fingers.
Grade 3 uses the medial borders of hands and fingers more deeply and
slowly.

29. Clapping (Cupping)
• It performed with your palms facing
downwards, forming a hollow curve.
Strike the part with the palmar surface
of the hand. The striking sound should
be hollow like a horse trotting. Use both
hand alternatively and strike rapidly.
• Effects
The exception of provoking a tendon
or muscle reflex

30. • Classification of Clapping
Grade 1 clapping is very superficial and is often called skin clapping.
This is performed at a fairly fast pace with minimal contact.
Grade 2 clapping is deeper, slower and firmer.
Grade 3 clapping is very firm and may involve elbow as well wrist
action.

31. Beating
• Involves the use of lightly clenched
fists to hit the area
Classifications of beating
Grade 1 beating is performed at a
fast rate, with fairly light contact.
Grade 2 is slower, with firmer contact.
Grade 3 is very deep and the rate
can be varied as required.

32. Pounding
• The hands are held in lightly
clasped with the thumbs resting
against the first fingers
• Classifications of beating
Grade 1 of this stroke applies to a
fast rate with light contact.
Grade 2 is used at a slower rate
with firmer contact
Grade 3 is deeper, with varying rates.

33. Tapping
• Tapping is done the tips or pads
of the fingers. It is used on very
small areas such as the face.
• Classifications of beating
Grade 1 of this stroke applies to a
fast rate with light contact.
Grade 2 is used at a slower rate with
firmer contact
Grade 3 is deeper, with varying rates.

34. Vibration
• A fine tremulous movement, made by the hand or fingers placed firmly
against a part, will cause the part to vibrate.
• Tips of the finger or whole hand is used for
vibration.
• Vibration involves a movement in which
the tissues are pressed and released
using an up and down motion.
• Effects
• Stimulates muscle tone.
• Stimulates the local circulation.
• Provides a feeling of well-being.

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

36. Contraindications
• Acute inflammatory conditions
• Severe varicose veins
• Open wounds
• Skin infections
• Failed or incomplete fracture healing
• Thrombophlebitis , Thrombosis
• Pregnant women
• Immediately after surgery