Introduction to Massage Therapy

@Physiocouk #manchesterphysio facebook.com/physiocouk
An Introduction to
Massage Therapy

Welcome
An Introduction to Massage Therapy
With Katie Emmett & Zoe Killian

http://massage.physio.co.uk/
Katie’s LinkedIn: www.linkedin.com/katieemmett
Twitter: @KatiePhysiocouk
Zoe’s LinkedIn: www.linkedin.com/zoekillian
Twitter: @ZoePhysiocouk
Who are we?

Let’s chat…

Let’s connect
Website: www.massage.physio.co.uk
Twitter: @physiocouk
Facebook: www.facebook.com/physiocouk

Aims of today
✓ Learn and understand basic anatomy
✓ Learn and understand contraindications and when to use
massage
✓ Learn the different massage techniques
✓ Demonstrate massage techniques to areas of the body

This course does not qualify you / cover
you to perform massage to clients.

Theory

Background: The History of Massage
• Massage is one of the oldest forms of manual therapy dating back as early as
1800BC, used in Eastern cultures as a method of healing and for therapeutic
purposes.
• If we have an area in the body that feels painful, our natural instinct is to rub it
in order to soothe the pain.
• The use of touch to soothe and heal.
• Used in Ancient Rome to treat diseases and physical injuries that the
gladiators and chariot racers may have had.

Background: The History of Massage
• Hieroglyphics found on the tomb of Ankmahor who was the physician of
the Pharaoh of Ancient Egypt, showing images of massage techniques.
• Originally, considered distasteful and sinful in Europe so the use of
massage was rejected.
• Pehr Henrick Ling introduced Swedish Massage in the 19th Century as a
method to treat athletes and sports people.
• Pehr Henrick Ling introduced the main foundations of all massage
techniques

Anatomy: Anatomical
Positioning
The definition of the anatomical position is as follows;
“The erect position of the body with the face directed forward, the arms
at the side, and the palms of the hands facing forward, used as a
reference in describing the relation of body parts to one another”
The anatomical position is important as we use it as a basis for our
anatomical terms. It helps us to describe the relation of body parts to one
another without any confusion.

Anatomy: Anatomical
Positioning

Anatomy: Anatomical Terminology
Anatomical Planes:
Median Sagittal plane: This is the plane which divides the body into
equal right and left halves.
Frontal plane: It is a vertical plane dividing us into equal front and back
halves. It is also known as coronal plane.
Transverse plane: It is the horizontal plane of the body. This divides the
top half of our body from the bottom half of our body

Positioning
Prone: This describes a person lying on their front facing downwards
Supine: This describes a person lying on their back facing upwards
Anterior: Means towards the front
Posterior: Means towards the back
Medial: Means towards the median plane of the body (midline)
Lateral: Means away from the median plane of the body
Superior: Means towards the head
Inferior: Means towards the feet

Movements
Abduction: A movement away from the central axis
Adduction: A movement towards the central axis
Medial Rotation: A rotation in direction of the medial side of the body
Lateral Rotation: A rotation towards the lateral side of the body (away from
the midline)
Flexion: A movement that decreased the angle of a joint
Extension: A movement that increased the angle of a joint

Anatomy: The Muscular
System: Functions
The muscular system is what allows the human body to move. The muscular system
makes up approximately half of a person’s body weight with roughly 700 named
muscles. Each muscle has its own origin and insertion with its own role.
The main functions of the muscular system include:
• Movement: Muscles are the only soft tissue within the body that has the ability to
contract and therefore create movement.
• Maintenance of posture and body position: Muscles are needed to contract in
order to hold body positions rather than just create movement. Muscles have great
endurance as they keep us in an upright position all day without becoming tired very
easily.

System: Functions
- Respiration: The muscular system involuntarily drives the movement of air
in and out of the body.
- Heat generation: The contraction of muscles creates heat which is mostly
important in controlling homeostasis.
-

System: Characteristics
There are four main characteristics or properties of the muscular system
that all muscle cells share. These are:
- Contractility: This means the muscle tissues have the ability to shorten.
This is seen when you need to flex your elbow for example, your biceps
muscles need to contract (shorten) in order to decrease the angle of the
joint.
- Excitability: This means the muscle tissues are able to respond to a
stimulus delivered by motor neurons or hormones.

System: Characteristics
- Extensibility: This means the muscle tissues have the ability to be stretched.
This again can be seen on flexion of the elbow. In order for the angle to
decrease, the elbow extensor muscles e.g. the triceps need to be able to
lengthen or extend to allow the flexion movement
- Elasticity: This means the muscle tissues have the ability to recoil or return
to the muscles original length post stretching.

There are three types of muscle tissues:
• Skeletal- striated, tubular and multi-nucleated fibres.
These are mostly found attached to bones in order to
create movement. They are the only muscle type that is
voluntarily controlled.
• Cardiac- striated, branched and uni-nucleated fibres. This
is and involuntary muscle found only in the heart.
• Smooth muscles- spindle-shaped, non-striated, uni-
nucleated fibres. This is the weakest type of involuntary
muscle found mainly in organs.
Anatomy –Muscle tissue

System:
Skeletal Muscle
There are an estimated 700 skeletal muscles found within the human body
which are composed of water (70%), protein (23%) and minerals (7%).
Skeletal muscles are the main type of muscle that produce movement as
they generate a force during contraction that pulls on the bone to then
create movement.

System
Skeletal Muscle Structure
Skeletal muscle contains fibers that
gives them a striated appearance.
They are wrapped in a tough
connective tissue called epimysium
and attach to bones within the
body via tendons.
Each individual muscle fibre
contains myofibrils that are made
up of the proteins myosin and actin
that are arranged into sarcomeres.
These are what create muscle
contraction.
Skeletal Muscle Functions
• Provides support for other body
structures
• Protects and supports the body’s
internal organs
• Aids in movement
• Blood cell formation
• Can be used to store calcium and
phosphate for things such as
muscle contraction and nerve cell
function

Macro structure

Muscle Anatomy
Upper Limb
The upper limb consists of your shoulder, upper arm, forearm, wrist and
hand. There are a range of muscles that make up the upper limb that will be
included within your massage.

Muscle Anatomy
Biceps Deltoids
Triceps Pronator Teres
Brachioradialis

Muscle Anatomy
Trunk
The trunk or torso refers to the central part of your body that your neck and
limbs extend from. It is made up of your neck, back and tummy areas. The
muscles involved within a massage around the trunk include:

Anatomy: Trunk
Trapezius
Levator Scapulae Latissimus Dorsi
Rhomboids Erector Spinae
Quadratus Lumborum

Muscle Anatomy
Lower Limb
The Lower limbs are made up of the hips, legs, ankle and foot. There
are various muscles that make up the lower limb. The main muscles a
lower limb massage would concentrate on include:

Anatomy: Lower Limb
Gluteals
Hamstrings
Soleus
Tibialis Anterior
Quadriceps
Gastrocnemius

Benefits of Massage
Physical and Psychological benefits
Physical benefits are those that have an effect on the physical state of the body. This can
include effects on the blood circulatory system, the lymphatic system, the muscular
system and the nervous system.
Physical benefits can include:
 Increased Relaxation
 Increased Flexibility
 Reduced Pain- both
chronic and acute
 Maintenance of
healthy muscles
 Reduced Swelling
 Improved Recovery
 Increased Healing
 Reduced
tension/tightness
 Improved Circulation
 Improved Posture
 Reduced Muscle Spasms
 Improved Sensation

Benefits of Massage
Psychological benefits are benefits that help a person mentally. The main reason for this is
due to the reduced circulation of cortisol, more commonly known as your stress hormone,
that occurs during a massage. As well as this, massage also encourages an increase in our
‘feel good’ or positive hormones such as endorphins, dopamine and serotonin.
Psychological benefits can include:
 Reduced Stress
 Increased Relaxation
 Improved Mood  Improved Sleep
 Reduced Anxiety
 Promotes Increased
Energy
 Improved Concentration
 Reduced Fatigue
 Can Ease Depression

Equipment
To perform a basic massage, there are a few pieces of equipment you will need…
Plinth/Chair
Antiseptic Alcohol Wipes
Towels/Blankets/Pillows
Couch roll
Massage Medium

Massage Mediums
Choosing the right medium can depend on various things…
The main types of massage mediums used include:
Oil
Gel
Creams/Lotions Powder
Wax/Balm

Massage Mediums: Benefits and
limitations
Medium Benefits Limitations
Oil • Provides a high glide
• Nourishing for the skin
• Lasts longer so more
economical
• Heats up quickly
• Can leave a sticky residue on
the skin
• Can stain clothes
• If any is spilt, it is very
slippery so can be hazardous
Lotions/Creams • Provide a medium glide
• Non sticky
• Nourishing for the skin
• Usually non slip so allows
more control
• Can leave the skin feeling
dried out
• Takes longer to warm up
• Can often be scented which
some people dislike
Wax/Balm • High level of control
• Increased grip
• Due to its thick texture, it is
not suitable for clients with
more body hair
• Harder to maintain hygiene
as it comes in a tub so
require use of a spatula
• Most are blended with
almond oil so can be an issue
for those with nut allergies

Massage Mediums: Benefits and
limitations Cont.
Medium Benefits Limitations
Powder • Provides a good grip
• Allows more control
• Not absorbed so reapplication
can be reduced
• A lot of powder is needed to
give the results
• Harder to use on those with
more body hair
• Does not offer much glide
• Not suitable for skin
conditions such as eczema or
dry skin
Gel • Allows a good glide
• Nourishes the skin
• Warms up quickly
• Non greasy
• Do not easily stain clothes
• Can leave a sticky residue
• Reapplication may be needed
more regularly as the skin
soaks it in faster

Contra-indications of Rx
Does any one know what a contra-indication is?

• A contraindication is something that would prevent treatment from taking
place to either one area or altogether.
• Local contraindications would prevent treatment in that area. For example,
if someone had a broken leg, you wouldn’t massage that leg… but that wont
stop you from massaging the opposite leg.
• Systemic contraindications can prevent treatment altogether as they would
be deemed hazardous to the persons health and/or wellbeing.
• The main Local and systemic contraindications to be aware of include:

Local Systemic
Broken skin/Open cuts Cancer (Malignancy)
Skin conditions Acute Circulatory disorders
Haematoma Blood Thinning Medications (e.g.
Warfarin)
Healing Fracture Bleeding disorders (e.g.
Haemophilia)
Active infections Systemic Infection
Obstructive Oedema
Acute RA
Advanced Diabetes

Precautions of Rx
• Pregnancy
• Hypersensitivity
• Hyper or Hypo- tension (High or Low blood pressure)
• Patient Anxiety
• Acute/ Inflammatory stage of healing
Precautions are things to look out for that could affect treatment. They
wont necessarily prevent treatment from taking place but could mean
you need to adjust or adapt the treatment to prevent any adverse
reactions.
The main precautions to look out for before treatment include:

Methods and
Techniques

Effleurage
• Effleurage is a technique performed using a gentle pressure using flat
hands and fingers. It is commonly used to begin a massage treatment but
can also be used between deeper style techniques to sooth over and relax
the soft tissues.
• Effleurage is useful in increasing blood circulation and the temperature of
soft tissues in order to prepare them for deeper techniques. It is also a
common technique used within therapeutic massage due to the slow pace
it is performed and the light pressures used to help relax muscles,
decrease stress and reduce tension.
• There are many different ways effleurage can be performed depending on
the muscle area and the reason for use…

Effleurage

Effleurage
Superficial effleurage is used to start and finish a
massage. Both hands are used next to each other
to create a light pressure
Forearm stroke is performed with the forearm. It can
be used to apply a deeper pressure between
techniques and saves your hands!

Effleurage
Reinforced effleurage is used after superficial and involves having one
hand on top of the other to produce a deeper pressure
Cam and spindle is performed with one
flat hand and the other in a fist shape
holding the opposite thumb. This helps to
add pressure and control the movement.

Petrissage
• Petrissage refers to a category or group of massage techniques. The
movements within the Petrissage group compress soft tissues together or
against underlying bone(s) to help relax the muscle tissues.
• Petrissage techniques are applied slowly but rhythmically using either one
of 2 hands.
• This group of techniques can be stimulative for the blood circulation and
the nervous system and as well as this, they can help to improve muscle
tone, increase removal of waste products and toxins and breakdown
tension and tightness within muscles.

Petrissage

Petrissage
Kneading is a circular technique that involves compressing soft
tissues. Tissues can be lifted, rolled and squeezed in a
compressive action using a varied pressure. Kneading can be
used with either one or two hands depending on the muscle area
and the desired outcome. It is a useful technique that helps to
break down restrictive tissue and reduce pain.
Thumb kneading is similar to regular kneading in that it
involves compressing soft tissues through rolling and
squeezing actions. The difference being that only thumbs are
used to produce the effect. Thumb kneading is useful at
targeting smaller muscle areas to help strip through muscular
tension to break down muscular knots.

Petrissage Continued…
Skin rolling/picking is a technique performed using thumb and fingers to pull
skin away from the tissue. The thumb and fingers are used to roll the skin
forwards in a constant motion to help separate it from the muscle. It is used
for releasing muscular knots and adhesions but can also produce a
therapeutic effect by reducing stress levels.

Petrissage Continued…
Wringing is a techniques that involves manipulation of the
soft tissues. The tissues are lifted and wrung from side to
side or in a side to side motion. Wringing compresses soft
tissues against their underlying structures and then gently
pulled away using the hands and fingers. Wringing is useful
in stimulating the skin, increasing removal of waste
products from the tissues and improving tissue elasticity.
Ironing is a deeper style technique used to compress
soft tissues. Ironing is performed using a clenched fist
and often with the opposite hand supporting the wrist
for either more control or to help apply a deeper
pressure. Ironing is useful in stimulating the blood
circulation, stretching soft tissues and encouraging
removal of waste products and toxins from the
muscles.

Tapotement

Tapotement
• Hacking is a percussion movement. Hacking is performed lightly but at a
fast pace. Using the sides of both hands, they will strike the muscle areas
alternately. Hacking can be used as a stimulative technique for the
nervous and circulatory system and can be used alongside other
percussion techniques.

Tapotement
• Beating and pounding is another percussion technique. It is mainly
used on larger muscle areas such as the thighs. It is performed with
loosely clenched fists with the aim to produce a deeper effects to other
percussion techniques. Beating and pounding is also stimulative
technique for the blood circulation and is also used to loosen muscles
and improve muscle tone.

Tapotement
• Cupping again is a percussion technique. It is performed with the
hands in a loose ‘cup’ shape, formed by slightly bending the fingers
together. As in hacking, both hands will strike the muscle area
alternately at a pace suited to the client. The palm of the hand should
never touch the clients skin. Cupping stimulates blood flow and can be
used to help relieve tight muscles.

Post Treatment Aftercare
After you have completed your massage, there are a couple of steps you
should follow in order to provide effective and efficient treatment aftercare…
1. Remove any excess oil from the skin: This helps to prevent staining of the
clients clothing and removes any sticky residue that may be uncomfortable
for the client.
2. Advise your client to slowly sit them selves up and, when necessary, advise
they can get changed back into their clothes. To protect your clients
modesty, you may need to leave the room whilst they do so.
3. Provide post treatment advice including:

Post Treatment Aftercare
 Post treatment irritation: It is common for people to experience some irritation after
treatment. Occasionally clients may feel tender to touch, achy, sleepy and sometimes even a bit
stiff however this is completely normal. It can take a couple of days before clients feel the full
benefits of treatment. This will depend on techniques used and the depth of the massage
provided.
 Reddening of the skin/skin irritation: This can be a result of various factors. Firstly heat is
produced during a massage due to friction created between the therapists hands and the
clients skin, which can give the red/pink effect on the skin. Increased circulation to our
superficial arteries through techniques such as effleurage can also cause coloring of the skin.
 Fluid intake: It is ALWAYS important to advise to increase water intake following a massage. It is
common for a massage to remove waste products and toxins from our body so drinking more
water will help to flush these out. It is also common for a person to feel faint or dehydrated
following a massage, again making it essential they drink plenty of fluid.

Practice techniques

Lunch…

Practical: Lower Limb
The Routine for the anterior massage is as follows:
Quadriceps (upper half of the front of the leg)
1. Effleurage – both hands
2. Reinforced effleurage- one hand on top of the
other
3. Forearm effleurage
4. Cam and spindle effleurage
5. Petrissage- Ironing
6. Effleurage
7. Petrissage- reinforced thumb kneading
8. Petrissage- kneading/wringing/picking up
9. Tapotement- Hacking/Cupping/Beating
10.Effleurage
Tibialis anterior (lower half of the front of the leg)
1. Effleurage – one flat hand
2. Reinforced effleurage- using palm
3. Petrissage- thumb kneading
4. Petrissage- thumb kneading with leg flexed at the
knee
EFFLEURAGE WHOLE LEG TO FINISH

Practical: Lower Limb Cont…
The routine for the upper posterior leg massage is as
follows:
Hamstrings (upper half of the back of the leg)
other
5. Petrissage- Ironing
6. Effleurage
7. Petrissage- reinforced thumb kneading
9. Tapotement- Hacking/Cupping/Beating
10.Effleurage
You may notice that this is similar to
the same as the anterior leg massage…
This is because the belly of muscle is a
similar size so the routine would
normally be the same as well.
It is common for techniques and
routines to over lap and adapted to
suit all areas of the body.

Practical: Lower Limb Cont …
The routine for the lower posterior leg is as follows:
Calf / Soleus Muscle
2. Reinforced effleurage- one hand on top of the other
5. Petrissage- Thumb kneading x 5
6. Effleurage
8. Effleurage to whole leg

Practical: Upper Limb
Whole arm
other
Upper arm
1. Petrissage- Kneading/thumb kneading
2. Effleurage
3. Petrissage- wringing
Repeat on forearm
1. Repeat steps from the upper arm
To finish, effleurage whole of arm
The routine for the upper limb (arms) is as follows:

Practical: Trunk
Trunk (Back + Shoulders)
1. Effleurage- both hands – 3 circles
Right Side
1. Reinforced effleurage- one hand on top of the other- 3 circles
3. Petrissage- kneading/wringing to shoulder
4. Reinforced effleurage- 3 circles
5. Petrissage- kneading/wringing to the side of the body
6. Tapotement- hacking/cupping/beating
8. Reinforced effleurage – 3 circles
Left side
1. Repeat steps from right side
To finish
1. Petrissage (kneading/wringing) across the body.
2. Effleurage with both hands to both sides
The routine for the trunk is as follows:

Thanks for coming!
Don’t forget to follow us on Twitter: @physiocouk

Introduction to Massage Therapy

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