Massage therapy has been practiced for millennia and involves manipulating the soft tissues of the body through techniques like effleurage, petrissage, and friction. It can provide physiological benefits like relaxation, reduced pain, and increased blood flow. The history of massage therapy is traced back to ancient civilizations but modern techniques were developed in the 19th century primarily in Europe and Sweden.

1. Massage TherapyMassage Therapy

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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. ReferencesReferences
 ImagesImages
 http://www.google.comhttp://www.google.com