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Presented By :-Presented By :-
RADHIKARADHIKA
CHINTAMANICHINTAMANI
CONTENTSCONTENTS
 DefinitionDefinition
 Introduction & HistoryIntroduction & History
 TypesTypes
 Relevant anatomy and physiologyRelevant anatomy and physiology
 Effects of therapeutic massageEffects of therapeutic massage
 Application techniques: assessment andApplication techniques: assessment and
treatmenttreatment
 IndicationsIndications
 ContraindicationContraindication
DefinitionDefinition
 ““Massage is the term used to express certain scientificMassage is the term used to express certain scientific
manipulations, which are performed by the hands of the operatormanipulations, which are performed by the hands of the operator
upon the body of the patient. It is a means used for creating energy,upon the body of the patient. It is a means used for creating energy,
where such has become exhausted , from whatsoever cause and is awhere such has become exhausted , from whatsoever cause and is a
natural method of restoring the part either locally or generallynatural method of restoring the part either locally or generally
injured, to its normal condition.”injured, to its normal condition.”
Massuse’s Pcketbook (1907)Massuse’s Pcketbook (1907)
 ““The scientific manipulation of the soft tissues of the body apartThe scientific manipulation of the soft tissues of the body apart
from mere rubbing.”from mere rubbing.”
Prosser (1941)Prosser (1941)
 ““Technically it can be described as therapeutic manipulation of softTechnically it can be described as therapeutic manipulation of soft
tissue.”tissue.”
Vickers (1996)Vickers (1996)
Introduction & HistoryIntroduction & History
 The word massage comes from ‘mass’ the Arabic term denoting ‘toThe word massage comes from ‘mass’ the Arabic term denoting ‘to
press’.press’.
 Massage is used therapeutically since ages by many civilization fromMassage is used therapeutically since ages by many civilization from
5000 years ago.5000 years ago.
 Almost all civilizations like: Hindus of India, Chinese, Japanese, theAlmost all civilizations like: Hindus of India, Chinese, Japanese, the
Thai, ancient Egyptians, Greeks and Romans.Thai, ancient Egyptians, Greeks and Romans.
 Hippocrates described its medical uses as well.Hippocrates described its medical uses as well.
 Massage played an important role in Roman Bath concept as well.Massage played an important role in Roman Bath concept as well.
TypesTypes
 There are various types of massages like;There are various types of massages like;
A.A. Western forms of massage.Western forms of massage.
B.B. Shaitsu: a modern form of accupunctureShaitsu: a modern form of accupuncture
C.C. Tui-na: a form of accupressureTui-na: a form of accupressure
D.D. Anma (amma): Japanese massageAnma (amma): Japanese massage
E.E. Ayurvedic massageAyurvedic massage
Relevant anatomyRelevant anatomy
THE SKIN:
Functions:
1.Protection from dehydration,
chemicals, UV rays, trauma
2.Regulation of temperature in
order
3.Has various sensory nerve
endings: nociceptors, ruffini’s
corpuscles, pacini’s corpuscles,
Merkle’s disc, Meissner’s discs
4.Excretion of excess fluids
5.Production of Vitamin D
6.Absorption of drugs and some
other substances such as
essential oils
7.For immunity by acting as
barrier
Effects of Therapeutic MassageEffects of Therapeutic Massage
1.1. Mechanical effectsMechanical effects
 This effects is seen due to constant passage of hands over theThis effects is seen due to constant passage of hands over the
skin which removes dead surface cells and allows the sweatskin which removes dead surface cells and allows the sweat
glands, the hair follicles and the sebaceous glands to be free ofglands, the hair follicles and the sebaceous glands to be free of
obstruction and to function better.obstruction and to function better.
 The increased lubrication effect is seen in subjects withThe increased lubrication effect is seen in subjects with
desquamationdesquamation
 Used in management of scars by inducing space; thus looseningUsed in management of scars by inducing space; thus loosening
up the adhesion and inducing scar tissue mobilisation.up the adhesion and inducing scar tissue mobilisation.
Effects of Therapeutic MassageEffects of Therapeutic Massage
2. Physiological effects2. Physiological effects
A.A. Circulatory effects:Circulatory effects:
 Initial capillary constriction occurs in response to light pressureInitial capillary constriction occurs in response to light pressure
seen as a transient white lineseen as a transient white line
 Skin rolling a form of therapeutic massage release a histamineSkin rolling a form of therapeutic massage release a histamine
related substancerelated substance
 Massage helps to increase circulation of the skin due to intermittentMassage helps to increase circulation of the skin due to intermittent
pressure applied and relieved during massage.pressure applied and relieved during massage.
 Increased lymphatic drainageIncreased lymphatic drainage
 Improved venous return to heartImproved venous return to heart
B. Effects on nervous system:B. Effects on nervous system:
 Slow rhythmic stroking: gives relaxation effectSlow rhythmic stroking: gives relaxation effect
 Fast stroking gives: excitatory effectFast stroking gives: excitatory effect
 Deep massages: relaxation/inhibitory effectDeep massages: relaxation/inhibitory effect
C. Effects on Pain:C. Effects on Pain:
 Pain caused due to muscles under spasm, tightness: slow and deepPain caused due to muscles under spasm, tightness: slow and deep
massagemassage
 Pain due to irritation of muscle in acute stages like muscle tear:Pain due to irritation of muscle in acute stages like muscle tear:
massage is contraindicatedmassage is contraindicated
 Pain due to muscular pressure on nerves: Radiculopathy: deep massagePain due to muscular pressure on nerves: Radiculopathy: deep massage
along the neuromuscular interface till the end point of radiating pain.along the neuromuscular interface till the end point of radiating pain.
D. Effects on Musculoskeletal system:D. Effects on Musculoskeletal system:
 Slow deep massage: Reducing tone in spasmodic musclesSlow deep massage: Reducing tone in spasmodic muscles
 Quick stroking massage: Improving tone in flaccid muscleQuick stroking massage: Improving tone in flaccid muscle
 Constant deep massage: Improves the flexibility as well as extensibility of the muscleConstant deep massage: Improves the flexibility as well as extensibility of the muscle
 Helps in relaxationHelps in relaxation
E. Effects on Psychological system:E. Effects on Psychological system:
 Massage helps in relieving tension/anxious moods by inducing somatic arousal andMassage helps in relieving tension/anxious moods by inducing somatic arousal and
reducing tension with the muscle indirectly reducing anxiety in subjects.reducing tension with the muscle indirectly reducing anxiety in subjects.
 Increase in sympathetic activityIncrease in sympathetic activity
 Pain caused due to muscles under spasm, tightness: slow and deep massagePain caused due to muscles under spasm, tightness: slow and deep massage
 Pain due to irritation of muscle in acute stages like muscle tear: massage is contraindicatedPain due to irritation of muscle in acute stages like muscle tear: massage is contraindicated
 Pain due to muscular pressure on nerves: Radiculopathy: deep massage along thePain due to muscular pressure on nerves: Radiculopathy: deep massage along the
neuromuscular interface till the end point of radiating pain.neuromuscular interface till the end point of radiating pain.
Application techniques:Application techniques:
A. AssessmentA. Assessment Assessment of part to beAssessment of part to be
massaged is done by followingmassaged is done by following
methods:methods:
i.i. ObservationObservation::
Postural evaluationPostural evaluation::
Observation of each bonyObservation of each bony
landmark or joint and itslandmark or joint and its
position with respect toposition with respect to
contralateral side. Eg forcontralateral side. Eg for
dysfunction: pectoralisdysfunction: pectoralis
tightness: shoulder goes intotightness: shoulder goes into
protraction which is viewed asprotraction which is viewed as
protracted shoulder in lateralprotracted shoulder in lateral
view posture analysis.view posture analysis.
A. Assessment Continued..A. Assessment Continued..
- Observe during movements:Observe during movements:
for any muscular tightnessfor any muscular tightness
while performing movement.while performing movement.
Eg: compare the angle of HipEg: compare the angle of Hip
flexion with knee extensionflexion with knee extension
in supine: if one leg is of lessin supine: if one leg is of less
angle actively and reaches toangle actively and reaches to
equal angle when doneequal angle when done
passively; indicates tightness.passively; indicates tightness.
Respective to the angleRespective to the angle
various muscles are tight.various muscles are tight.
Angles of hip flexion and pain occurring varies with the type of dysfunction.
a. 0-30: hip joint pain
b. 30-70: sciatica: Massage is sometimes used to treat
c. 70-120: hamstring muscle dysfunction: Massage is used to treat
d. 120 and above: SI joint pain
Angles of hip flexion and pain occurring varies with the type of dysfunction.
a. 0-30: hip joint pain
b. 30-70: sciatica: Massage is sometimes used to treat
c. 70-120: hamstring muscle dysfunction: Massage is used to treat
d. 120 and above: SI joint pain
ii.ii. Palpation: there are various softPalpation: there are various soft
tissue palpation techniques, usedtissue palpation techniques, used
to assess the muscle turgour.to assess the muscle turgour.
These techniques involveThese techniques involve
superficial and deep palpationsuperficial and deep palpation
A.A. Flat palpation technique: forFlat palpation technique: for
flatter muscles and moreflatter muscles and more
superficially located onessuperficially located ones
B.B. Snapping palpation technique: forSnapping palpation technique: for
cord like structures which arecord like structures which are
deeply locateddeeply located
C.C. Pincer grasp: for superficial bulkPincer grasp: for superficial bulk
like biceps brachiilike biceps brachii
B. Massage manipulationB. Massage manipulation
techniquestechniques
There are various types of technique performed differentlyThere are various types of technique performed differently
also used for different conditions:also used for different conditions:
1.1. EffleurageEffleurage
2.2. PetrissagePetrissage
3.3. MF TrP TherapyMF TrP Therapy
4.4. RollingRolling
5.5. StrokingStroking
6.6. Deep tissue massageDeep tissue massage
1.1. EffleurageEffleurage
 It is a unidirectional manipulation in which the practitionersIt is a unidirectional manipulation in which the practitioners
hand passes from distal to proximal with a depth compatiblehand passes from distal to proximal with a depth compatible
with the state of the tissues and the desired effect.with the state of the tissues and the desired effect.
 Manipulation usually starts at one end and proceedsManipulation usually starts at one end and proceeds
proximally, thus draining the part underneath.proximally, thus draining the part underneath.
 Aims:Aims:
i.i. Assists venous and lymphatic drainageAssists venous and lymphatic drainage
ii.ii. Assists fluid interchangeAssists fluid interchange
iii.iii. Assists in relaxation of the subject due to sedative effectAssists in relaxation of the subject due to sedative effect
iv.iv. Helps in decreasing or increasing muscle tone.Helps in decreasing or increasing muscle tone.
v.v. Passively stretches the fibers.Passively stretches the fibers.
 Subjects position: relaxedSubjects position: relaxed
position of the part to beposition of the part to be
treated.treated.
 Therapists position: StepTherapists position: Step
standingstanding
 Hand position: PerformedHand position: Performed
with whole hand, softlywith whole hand, softly
curved and relaxed to fitcurved and relaxed to fit
the part, should be placedthe part, should be placed
obliquely on the skin. Bothobliquely on the skin. Both
hands can also be used tohands can also be used to
treat.treat.
2. Stroking2. Stroking
 It is a unidirectional manipulation in which the practitionersIt is a unidirectional manipulation in which the practitioners
hand passes usually from proximal to distal down the lengthhand passes usually from proximal to distal down the length
of the tissues at speed compatible with the desired effect. Theof the tissues at speed compatible with the desired effect. The
direction of stroking may be varied to give greater comfort.direction of stroking may be varied to give greater comfort.
The depth of the stroking is minimal in order to induceThe depth of the stroking is minimal in order to induce
relaxation/stimulating.relaxation/stimulating.
 Aims:Aims:
i.i. Assists in creating sedative effect (slow): one stroke per 5Assists in creating sedative effect (slow): one stroke per 5
secondsseconds
ii.ii. Assists in creating a stimulating effect (fast): four strokes perAssists in creating a stimulating effect (fast): four strokes per
5 seconds5 seconds
 Subjects position: relaxed positionSubjects position: relaxed position
of the part to be treated.of the part to be treated.
 Therapists position: Step standingTherapists position: Step standing
 Hand position: stroke should startHand position: stroke should start
with a firm contact and finish withwith a firm contact and finish with
a smooth lift off of hands. The handa smooth lift off of hands. The hand
can be positioned obliquely so thatcan be positioned obliquely so that
heel travels first, but application isheel travels first, but application is
only by the finger tips.only by the finger tips.
i.i. One hand: narrow area like thighsOne hand: narrow area like thighs
ii.ii. Two hands: broader area like backTwo hands: broader area like back
““Thousand hands technique”Thousand hands technique”
One hand performs a short stroke, theOne hand performs a short stroke, the
second hand does pass over onesecond hand does pass over one
another to gain contact as theanother to gain contact as the
manipulation proceeds down the lengthmanipulation proceeds down the length
of the part under treatmentof the part under treatment
3. Petrissage3. Petrissage
 It is a type of massage manipulation in which the soft tissuesIt is a type of massage manipulation in which the soft tissues
are compressed either against underlying bone or againstare compressed either against underlying bone or against
themselves.themselves.
 Aims:Aims:
i.i. Assists venous and lymphatic drainageAssists venous and lymphatic drainage
ii.ii. Assists fluid interchangeAssists fluid interchange
iii.iii. Increases mobility of underlying tissueIncreases mobility of underlying tissue
iv.iv. Has an effect on somatovisceral reflexesHas an effect on somatovisceral reflexes
 Petrissage are divided into:Petrissage are divided into:
I.I. KneadingKneading
II.II. Picking up manipulationPicking up manipulation
III.III.WringingWringing
IV.IV.RollingRolling
V.V. ShakingShaking
I. KneadingI. Kneading
 It is a type of circular manipulation performed so that theIt is a type of circular manipulation performed so that the
skin and subcutaneous tissue are moved in a circular mannerskin and subcutaneous tissue are moved in a circular manner
on the underlying structures.on the underlying structures.
 The circle is described by the part of your hand in contact.The circle is described by the part of your hand in contact.
 The actual range or number of degrees for which pressure isThe actual range or number of degrees for which pressure is
exerted varies with the part to be treated.exerted varies with the part to be treated.
 Subjects position: relaxed positionSubjects position: relaxed position
of the part to be treated.of the part to be treated.
 Therapists position: Stride standingTherapists position: Stride standing
 Hand position: performed with;Hand position: performed with;
- Whole hand kneadingWhole hand kneading
- Palmar kneadingPalmar kneading
- With fingers only: flat fingerWith fingers only: flat finger
kneading, finger pad kneading andkneading, finger pad kneading and
finger tip kneading.finger tip kneading.
- With the thumb: thumb padWith the thumb: thumb pad
kneading and thumb tip kneadingkneading and thumb tip kneading
- Both hands when one isBoth hands when one is
superimposed on the othersuperimposed on the other
- Double handed: alternatively orDouble handed: alternatively or
simultaneouslysimultaneously
II. Picking UpII. Picking Up
 It is a type of manipulation in which tissues are compressedIt is a type of manipulation in which tissues are compressed
against underlying bone, then lifted, squeezed and released.against underlying bone, then lifted, squeezed and released.
 The manipulation is often performed single handed with stheThe manipulation is often performed single handed with sthe
thumb and thenar eminence as one component and thethumb and thenar eminence as one component and the
medial two or three fingers and hypothenar eminence as themedial two or three fingers and hypothenar eminence as the
other component of the grasp.other component of the grasp.
 Types of grasp:Types of grasp:
A.A. ‘‘C’- shaped grasp: for wider or larger areasC’- shaped grasp: for wider or larger areas
B.B. ‘‘V’-shaped grasp: for narrower areas.V’-shaped grasp: for narrower areas.
 The cleft between the thumb and index finger should alwaysThe cleft between the thumb and index finger should always
be in contact with the subjects skin, otherwise it has abe in contact with the subjects skin, otherwise it has a
pinching effect and the depth of massage is lost.pinching effect and the depth of massage is lost.
 The technique is performed with arms held in slightThe technique is performed with arms held in slight
abduction and elbows semi-flexed.abduction and elbows semi-flexed.
III. WringingIII. Wringing
 It is a type ofIt is a type of
manipulation in whichmanipulation in which
tissues are compressedtissues are compressed
against underlyingagainst underlying
structures, then, pullstructures, then, pull
them with one handthem with one hand
while pushing them inwhile pushing them in
the prior mentionedthe prior mentioned
direction with the thumbdirection with the thumb
of opposite hand.of opposite hand.
 Basically the structure toBasically the structure to
be treated is wringedbe treated is wringed
between two handsbetween two hands
 It is a type ofIt is a type of
manipulation in whichmanipulation in which
tissues are lifted andtissues are lifted and
rolled between thumbsrolled between thumbs
and fingers of the twoand fingers of the two
hands.hands.
 Two types:Two types:
A.A. Skin rolling: performedSkin rolling: performed
on back, abdomen,on back, abdomen,
thighs, knees and on scarthighs, knees and on scar
tissues.tissues.
B.B. Muscle rolling:Muscle rolling:
performed by workingperformed by working
along the long axis of thealong the long axis of the
IV. RollingIV. Rolling
 Skin rollingSkin rolling
 Muscle rollingMuscle rolling
WringingWringing RollingRolling
V. Muscle shakingV. Muscle shaking
 Long bellies may be shaken andLong bellies may be shaken and
muscle manipulation can bemuscle manipulation can be
performed on the larger musclesperformed on the larger muscles
likes: biceps brachii, tricepslikes: biceps brachii, triceps
brachii, quadriceps, gastrocnemiusbrachii, quadriceps, gastrocnemius
and also on the small muscles ofand also on the small muscles of
thenar and hypothenar eminences.thenar and hypothenar eminences.
 Movement of the model isMovement of the model is
sideways and involves rapid radialsideways and involves rapid radial
and ulnar deviation of the wrist.and ulnar deviation of the wrist.
FrictionFriction
 Frictions are small range, deep manipulationsFrictions are small range, deep manipulations
performed on specific anatomical structuresperformed on specific anatomical structures
with the tips of the fingers or thumbs (no otherwith the tips of the fingers or thumbs (no other
part of the therapist hand must come in contactpart of the therapist hand must come in contact
with the subject body part to be treated)with the subject body part to be treated)
 Two types:Two types:
A.A. Circular: performed with finger tipsCircular: performed with finger tips
B.B. Transverse: advocated by James cyriax: knownTransverse: advocated by James cyriax: known
as cyriax deep transverse friction massageas cyriax deep transverse friction massage
CircularCircular
 Finger tips only in a circularFinger tips only in a circular
manner with graduallymanner with gradually
increasing depth for three orincreasing depth for three or
four circles.four circles.
 The pressure is released andThe pressure is released and
manipulated againmanipulated again
 One hand can reinforceOne hand can reinforce
other.other.
TransverseTransverse
 To and fro movementTo and fro movement
 Pronosupination graspPronosupination grasp
 Pincer graspPincer grasp
 Pulp of thumbPulp of thumb
To and Fro movement:To and Fro movement:
Used for round and flat surfaces.Used for round and flat surfaces.
To and Fro movement:To and Fro movement:
Used for round and flat surfaces.Used for round and flat surfaces.
Types of grips for Cyriax deepTypes of grips for Cyriax deep
friction massagefriction massage
Pronosupination grasp:
For more deeply situated
lesions.
Pronosupination grasp:
For more deeply situated
lesions.
Pincer Grasp:
Usually for
trigger points.
Pincer Grasp:
Usually for
trigger points.
Pulp of Thumb:
For flat surfaces,
taut bands,
nodules in flat
surfaces
Pulp of Thumb:
For flat surfaces,
taut bands,
nodules in flat
surfaces
PercussionPercussion Percussion manipulations are those the treated part is struck softPercussion manipulations are those the treated part is struck soft
blows with the hand.blows with the hand.
 Whole hand contact/finger tip contact can be used.Whole hand contact/finger tip contact can be used.
 Six types:Six types:
A.A. Hacking: skin is struck using the back of the tip of three medialHacking: skin is struck using the back of the tip of three medial
fingersfingers
B.B. Clapping: whole palmar aspect is used to strike the body part (makeClapping: whole palmar aspect is used to strike the body part (make
sure the hand is cupped slightly)sure the hand is cupped slightly)
C.C. Vibration: involves a movement in which tissues are pressed andVibration: involves a movement in which tissues are pressed and
released using an up and down motionreleased using an up and down motion
D.D. Beating: dorsal aspect of middle phalanx of loosely clenched fistBeating: dorsal aspect of middle phalanx of loosely clenched fist
(with thumb inside the fist) is used for the strike(with thumb inside the fist) is used for the strike
E.E. Pounding: ulnar aspect of loosely clenched fist is used to strikePounding: ulnar aspect of loosely clenched fist is used to strike
F.F. Tapping: with the tips of finger pads on a smaller are such as face;Tapping: with the tips of finger pads on a smaller are such as face;
index, ring and middle finger may be used together or in a singlyindex, ring and middle finger may be used together or in a singly
sequence.sequence.
 HackingHacking  ClappingClapping
 VibrationVibration  BeatingBeating
 PoundingPounding
 TappingTapping
IndicationsIndications
1.1. For tensed musclesFor tensed muscles
2.2. Muscular painMuscular pain
3.3. Tight musclesTight muscles
4.4. Blocked sinusBlocked sinus
5.5. Flaccid musclesFlaccid muscles
6.6. For relaxationFor relaxation
7.7. For scarsFor scars
ContraindicationsContraindications
1.1. Local cancerousLocal cancerous
lesionlesion
2.2. Open woundOpen wound
3.3. Skin allergiesSkin allergies
4.4. Deep veinDeep vein
thromobosisthromobosis
5.5. Skin infectionSkin infection
6.6. Operative conditionsOperative conditions
with implantswith implants
Therapeutic massage

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Therapeutic massage

  • 1. Presented By :-Presented By :- RADHIKARADHIKA CHINTAMANICHINTAMANI
  • 2. CONTENTSCONTENTS  DefinitionDefinition  Introduction & HistoryIntroduction & History  TypesTypes  Relevant anatomy and physiologyRelevant anatomy and physiology  Effects of therapeutic massageEffects of therapeutic massage  Application techniques: assessment andApplication techniques: assessment and treatmenttreatment  IndicationsIndications  ContraindicationContraindication
  • 3. DefinitionDefinition  ““Massage is the term used to express certain scientificMassage is the term used to express certain scientific manipulations, which are performed by the hands of the operatormanipulations, which are performed by the hands of the operator upon the body of the patient. It is a means used for creating energy,upon the body of the patient. It is a means used for creating energy, where such has become exhausted , from whatsoever cause and is awhere such has become exhausted , from whatsoever cause and is a natural method of restoring the part either locally or generallynatural method of restoring the part either locally or generally injured, to its normal condition.”injured, to its normal condition.” Massuse’s Pcketbook (1907)Massuse’s Pcketbook (1907)  ““The scientific manipulation of the soft tissues of the body apartThe scientific manipulation of the soft tissues of the body apart from mere rubbing.”from mere rubbing.” Prosser (1941)Prosser (1941)  ““Technically it can be described as therapeutic manipulation of softTechnically it can be described as therapeutic manipulation of soft tissue.”tissue.” Vickers (1996)Vickers (1996)
  • 4. Introduction & HistoryIntroduction & History  The word massage comes from ‘mass’ the Arabic term denoting ‘toThe word massage comes from ‘mass’ the Arabic term denoting ‘to press’.press’.  Massage is used therapeutically since ages by many civilization fromMassage is used therapeutically since ages by many civilization from 5000 years ago.5000 years ago.  Almost all civilizations like: Hindus of India, Chinese, Japanese, theAlmost all civilizations like: Hindus of India, Chinese, Japanese, the Thai, ancient Egyptians, Greeks and Romans.Thai, ancient Egyptians, Greeks and Romans.  Hippocrates described its medical uses as well.Hippocrates described its medical uses as well.  Massage played an important role in Roman Bath concept as well.Massage played an important role in Roman Bath concept as well.
  • 5. TypesTypes  There are various types of massages like;There are various types of massages like; A.A. Western forms of massage.Western forms of massage. B.B. Shaitsu: a modern form of accupunctureShaitsu: a modern form of accupuncture C.C. Tui-na: a form of accupressureTui-na: a form of accupressure D.D. Anma (amma): Japanese massageAnma (amma): Japanese massage E.E. Ayurvedic massageAyurvedic massage
  • 6. Relevant anatomyRelevant anatomy THE SKIN: Functions: 1.Protection from dehydration, chemicals, UV rays, trauma 2.Regulation of temperature in order 3.Has various sensory nerve endings: nociceptors, ruffini’s corpuscles, pacini’s corpuscles, Merkle’s disc, Meissner’s discs 4.Excretion of excess fluids 5.Production of Vitamin D 6.Absorption of drugs and some other substances such as essential oils 7.For immunity by acting as barrier
  • 7. Effects of Therapeutic MassageEffects of Therapeutic Massage 1.1. Mechanical effectsMechanical effects  This effects is seen due to constant passage of hands over theThis effects is seen due to constant passage of hands over the skin which removes dead surface cells and allows the sweatskin which removes dead surface cells and allows the sweat glands, the hair follicles and the sebaceous glands to be free ofglands, the hair follicles and the sebaceous glands to be free of obstruction and to function better.obstruction and to function better.  The increased lubrication effect is seen in subjects withThe increased lubrication effect is seen in subjects with desquamationdesquamation  Used in management of scars by inducing space; thus looseningUsed in management of scars by inducing space; thus loosening up the adhesion and inducing scar tissue mobilisation.up the adhesion and inducing scar tissue mobilisation.
  • 8. Effects of Therapeutic MassageEffects of Therapeutic Massage 2. Physiological effects2. Physiological effects A.A. Circulatory effects:Circulatory effects:  Initial capillary constriction occurs in response to light pressureInitial capillary constriction occurs in response to light pressure seen as a transient white lineseen as a transient white line  Skin rolling a form of therapeutic massage release a histamineSkin rolling a form of therapeutic massage release a histamine related substancerelated substance  Massage helps to increase circulation of the skin due to intermittentMassage helps to increase circulation of the skin due to intermittent pressure applied and relieved during massage.pressure applied and relieved during massage.  Increased lymphatic drainageIncreased lymphatic drainage  Improved venous return to heartImproved venous return to heart
  • 9. B. Effects on nervous system:B. Effects on nervous system:  Slow rhythmic stroking: gives relaxation effectSlow rhythmic stroking: gives relaxation effect  Fast stroking gives: excitatory effectFast stroking gives: excitatory effect  Deep massages: relaxation/inhibitory effectDeep massages: relaxation/inhibitory effect C. Effects on Pain:C. Effects on Pain:  Pain caused due to muscles under spasm, tightness: slow and deepPain caused due to muscles under spasm, tightness: slow and deep massagemassage  Pain due to irritation of muscle in acute stages like muscle tear:Pain due to irritation of muscle in acute stages like muscle tear: massage is contraindicatedmassage is contraindicated  Pain due to muscular pressure on nerves: Radiculopathy: deep massagePain due to muscular pressure on nerves: Radiculopathy: deep massage along the neuromuscular interface till the end point of radiating pain.along the neuromuscular interface till the end point of radiating pain.
  • 10. D. Effects on Musculoskeletal system:D. Effects on Musculoskeletal system:  Slow deep massage: Reducing tone in spasmodic musclesSlow deep massage: Reducing tone in spasmodic muscles  Quick stroking massage: Improving tone in flaccid muscleQuick stroking massage: Improving tone in flaccid muscle  Constant deep massage: Improves the flexibility as well as extensibility of the muscleConstant deep massage: Improves the flexibility as well as extensibility of the muscle  Helps in relaxationHelps in relaxation E. Effects on Psychological system:E. Effects on Psychological system:  Massage helps in relieving tension/anxious moods by inducing somatic arousal andMassage helps in relieving tension/anxious moods by inducing somatic arousal and reducing tension with the muscle indirectly reducing anxiety in subjects.reducing tension with the muscle indirectly reducing anxiety in subjects.  Increase in sympathetic activityIncrease in sympathetic activity  Pain caused due to muscles under spasm, tightness: slow and deep massagePain caused due to muscles under spasm, tightness: slow and deep massage  Pain due to irritation of muscle in acute stages like muscle tear: massage is contraindicatedPain due to irritation of muscle in acute stages like muscle tear: massage is contraindicated  Pain due to muscular pressure on nerves: Radiculopathy: deep massage along thePain due to muscular pressure on nerves: Radiculopathy: deep massage along the neuromuscular interface till the end point of radiating pain.neuromuscular interface till the end point of radiating pain.
  • 11. Application techniques:Application techniques: A. AssessmentA. Assessment Assessment of part to beAssessment of part to be massaged is done by followingmassaged is done by following methods:methods: i.i. ObservationObservation:: Postural evaluationPostural evaluation:: Observation of each bonyObservation of each bony landmark or joint and itslandmark or joint and its position with respect toposition with respect to contralateral side. Eg forcontralateral side. Eg for dysfunction: pectoralisdysfunction: pectoralis tightness: shoulder goes intotightness: shoulder goes into protraction which is viewed asprotraction which is viewed as protracted shoulder in lateralprotracted shoulder in lateral view posture analysis.view posture analysis.
  • 12. A. Assessment Continued..A. Assessment Continued.. - Observe during movements:Observe during movements: for any muscular tightnessfor any muscular tightness while performing movement.while performing movement. Eg: compare the angle of HipEg: compare the angle of Hip flexion with knee extensionflexion with knee extension in supine: if one leg is of lessin supine: if one leg is of less angle actively and reaches toangle actively and reaches to equal angle when doneequal angle when done passively; indicates tightness.passively; indicates tightness. Respective to the angleRespective to the angle various muscles are tight.various muscles are tight. Angles of hip flexion and pain occurring varies with the type of dysfunction. a. 0-30: hip joint pain b. 30-70: sciatica: Massage is sometimes used to treat c. 70-120: hamstring muscle dysfunction: Massage is used to treat d. 120 and above: SI joint pain Angles of hip flexion and pain occurring varies with the type of dysfunction. a. 0-30: hip joint pain b. 30-70: sciatica: Massage is sometimes used to treat c. 70-120: hamstring muscle dysfunction: Massage is used to treat d. 120 and above: SI joint pain
  • 13. ii.ii. Palpation: there are various softPalpation: there are various soft tissue palpation techniques, usedtissue palpation techniques, used to assess the muscle turgour.to assess the muscle turgour. These techniques involveThese techniques involve superficial and deep palpationsuperficial and deep palpation A.A. Flat palpation technique: forFlat palpation technique: for flatter muscles and moreflatter muscles and more superficially located onessuperficially located ones B.B. Snapping palpation technique: forSnapping palpation technique: for cord like structures which arecord like structures which are deeply locateddeeply located C.C. Pincer grasp: for superficial bulkPincer grasp: for superficial bulk like biceps brachiilike biceps brachii
  • 14. B. Massage manipulationB. Massage manipulation techniquestechniques There are various types of technique performed differentlyThere are various types of technique performed differently also used for different conditions:also used for different conditions: 1.1. EffleurageEffleurage 2.2. PetrissagePetrissage 3.3. MF TrP TherapyMF TrP Therapy 4.4. RollingRolling 5.5. StrokingStroking 6.6. Deep tissue massageDeep tissue massage
  • 15. 1.1. EffleurageEffleurage  It is a unidirectional manipulation in which the practitionersIt is a unidirectional manipulation in which the practitioners hand passes from distal to proximal with a depth compatiblehand passes from distal to proximal with a depth compatible with the state of the tissues and the desired effect.with the state of the tissues and the desired effect.  Manipulation usually starts at one end and proceedsManipulation usually starts at one end and proceeds proximally, thus draining the part underneath.proximally, thus draining the part underneath.  Aims:Aims: i.i. Assists venous and lymphatic drainageAssists venous and lymphatic drainage ii.ii. Assists fluid interchangeAssists fluid interchange iii.iii. Assists in relaxation of the subject due to sedative effectAssists in relaxation of the subject due to sedative effect iv.iv. Helps in decreasing or increasing muscle tone.Helps in decreasing or increasing muscle tone. v.v. Passively stretches the fibers.Passively stretches the fibers.
  • 16.  Subjects position: relaxedSubjects position: relaxed position of the part to beposition of the part to be treated.treated.  Therapists position: StepTherapists position: Step standingstanding  Hand position: PerformedHand position: Performed with whole hand, softlywith whole hand, softly curved and relaxed to fitcurved and relaxed to fit the part, should be placedthe part, should be placed obliquely on the skin. Bothobliquely on the skin. Both hands can also be used tohands can also be used to treat.treat.
  • 17. 2. Stroking2. Stroking  It is a unidirectional manipulation in which the practitionersIt is a unidirectional manipulation in which the practitioners hand passes usually from proximal to distal down the lengthhand passes usually from proximal to distal down the length of the tissues at speed compatible with the desired effect. Theof the tissues at speed compatible with the desired effect. The direction of stroking may be varied to give greater comfort.direction of stroking may be varied to give greater comfort. The depth of the stroking is minimal in order to induceThe depth of the stroking is minimal in order to induce relaxation/stimulating.relaxation/stimulating.  Aims:Aims: i.i. Assists in creating sedative effect (slow): one stroke per 5Assists in creating sedative effect (slow): one stroke per 5 secondsseconds ii.ii. Assists in creating a stimulating effect (fast): four strokes perAssists in creating a stimulating effect (fast): four strokes per 5 seconds5 seconds
  • 18.  Subjects position: relaxed positionSubjects position: relaxed position of the part to be treated.of the part to be treated.  Therapists position: Step standingTherapists position: Step standing  Hand position: stroke should startHand position: stroke should start with a firm contact and finish withwith a firm contact and finish with a smooth lift off of hands. The handa smooth lift off of hands. The hand can be positioned obliquely so thatcan be positioned obliquely so that heel travels first, but application isheel travels first, but application is only by the finger tips.only by the finger tips. i.i. One hand: narrow area like thighsOne hand: narrow area like thighs ii.ii. Two hands: broader area like backTwo hands: broader area like back ““Thousand hands technique”Thousand hands technique” One hand performs a short stroke, theOne hand performs a short stroke, the second hand does pass over onesecond hand does pass over one another to gain contact as theanother to gain contact as the manipulation proceeds down the lengthmanipulation proceeds down the length of the part under treatmentof the part under treatment
  • 19. 3. Petrissage3. Petrissage  It is a type of massage manipulation in which the soft tissuesIt is a type of massage manipulation in which the soft tissues are compressed either against underlying bone or againstare compressed either against underlying bone or against themselves.themselves.  Aims:Aims: i.i. Assists venous and lymphatic drainageAssists venous and lymphatic drainage ii.ii. Assists fluid interchangeAssists fluid interchange iii.iii. Increases mobility of underlying tissueIncreases mobility of underlying tissue iv.iv. Has an effect on somatovisceral reflexesHas an effect on somatovisceral reflexes
  • 20.  Petrissage are divided into:Petrissage are divided into: I.I. KneadingKneading II.II. Picking up manipulationPicking up manipulation III.III.WringingWringing IV.IV.RollingRolling V.V. ShakingShaking
  • 21. I. KneadingI. Kneading  It is a type of circular manipulation performed so that theIt is a type of circular manipulation performed so that the skin and subcutaneous tissue are moved in a circular mannerskin and subcutaneous tissue are moved in a circular manner on the underlying structures.on the underlying structures.  The circle is described by the part of your hand in contact.The circle is described by the part of your hand in contact.  The actual range or number of degrees for which pressure isThe actual range or number of degrees for which pressure is exerted varies with the part to be treated.exerted varies with the part to be treated.
  • 22.  Subjects position: relaxed positionSubjects position: relaxed position of the part to be treated.of the part to be treated.  Therapists position: Stride standingTherapists position: Stride standing  Hand position: performed with;Hand position: performed with; - Whole hand kneadingWhole hand kneading - Palmar kneadingPalmar kneading - With fingers only: flat fingerWith fingers only: flat finger kneading, finger pad kneading andkneading, finger pad kneading and finger tip kneading.finger tip kneading. - With the thumb: thumb padWith the thumb: thumb pad kneading and thumb tip kneadingkneading and thumb tip kneading - Both hands when one isBoth hands when one is superimposed on the othersuperimposed on the other - Double handed: alternatively orDouble handed: alternatively or simultaneouslysimultaneously
  • 23. II. Picking UpII. Picking Up  It is a type of manipulation in which tissues are compressedIt is a type of manipulation in which tissues are compressed against underlying bone, then lifted, squeezed and released.against underlying bone, then lifted, squeezed and released.  The manipulation is often performed single handed with stheThe manipulation is often performed single handed with sthe thumb and thenar eminence as one component and thethumb and thenar eminence as one component and the medial two or three fingers and hypothenar eminence as themedial two or three fingers and hypothenar eminence as the other component of the grasp.other component of the grasp.  Types of grasp:Types of grasp: A.A. ‘‘C’- shaped grasp: for wider or larger areasC’- shaped grasp: for wider or larger areas B.B. ‘‘V’-shaped grasp: for narrower areas.V’-shaped grasp: for narrower areas.
  • 24.  The cleft between the thumb and index finger should alwaysThe cleft between the thumb and index finger should always be in contact with the subjects skin, otherwise it has abe in contact with the subjects skin, otherwise it has a pinching effect and the depth of massage is lost.pinching effect and the depth of massage is lost.  The technique is performed with arms held in slightThe technique is performed with arms held in slight abduction and elbows semi-flexed.abduction and elbows semi-flexed.
  • 25. III. WringingIII. Wringing  It is a type ofIt is a type of manipulation in whichmanipulation in which tissues are compressedtissues are compressed against underlyingagainst underlying structures, then, pullstructures, then, pull them with one handthem with one hand while pushing them inwhile pushing them in the prior mentionedthe prior mentioned direction with the thumbdirection with the thumb of opposite hand.of opposite hand.  Basically the structure toBasically the structure to be treated is wringedbe treated is wringed between two handsbetween two hands  It is a type ofIt is a type of manipulation in whichmanipulation in which tissues are lifted andtissues are lifted and rolled between thumbsrolled between thumbs and fingers of the twoand fingers of the two hands.hands.  Two types:Two types: A.A. Skin rolling: performedSkin rolling: performed on back, abdomen,on back, abdomen, thighs, knees and on scarthighs, knees and on scar tissues.tissues. B.B. Muscle rolling:Muscle rolling: performed by workingperformed by working along the long axis of thealong the long axis of the IV. RollingIV. Rolling
  • 26.  Skin rollingSkin rolling  Muscle rollingMuscle rolling WringingWringing RollingRolling
  • 27. V. Muscle shakingV. Muscle shaking  Long bellies may be shaken andLong bellies may be shaken and muscle manipulation can bemuscle manipulation can be performed on the larger musclesperformed on the larger muscles likes: biceps brachii, tricepslikes: biceps brachii, triceps brachii, quadriceps, gastrocnemiusbrachii, quadriceps, gastrocnemius and also on the small muscles ofand also on the small muscles of thenar and hypothenar eminences.thenar and hypothenar eminences.  Movement of the model isMovement of the model is sideways and involves rapid radialsideways and involves rapid radial and ulnar deviation of the wrist.and ulnar deviation of the wrist.
  • 28. FrictionFriction  Frictions are small range, deep manipulationsFrictions are small range, deep manipulations performed on specific anatomical structuresperformed on specific anatomical structures with the tips of the fingers or thumbs (no otherwith the tips of the fingers or thumbs (no other part of the therapist hand must come in contactpart of the therapist hand must come in contact with the subject body part to be treated)with the subject body part to be treated)  Two types:Two types: A.A. Circular: performed with finger tipsCircular: performed with finger tips B.B. Transverse: advocated by James cyriax: knownTransverse: advocated by James cyriax: known as cyriax deep transverse friction massageas cyriax deep transverse friction massage
  • 29. CircularCircular  Finger tips only in a circularFinger tips only in a circular manner with graduallymanner with gradually increasing depth for three orincreasing depth for three or four circles.four circles.  The pressure is released andThe pressure is released and manipulated againmanipulated again  One hand can reinforceOne hand can reinforce other.other. TransverseTransverse  To and fro movementTo and fro movement  Pronosupination graspPronosupination grasp  Pincer graspPincer grasp  Pulp of thumbPulp of thumb
  • 30. To and Fro movement:To and Fro movement: Used for round and flat surfaces.Used for round and flat surfaces. To and Fro movement:To and Fro movement: Used for round and flat surfaces.Used for round and flat surfaces. Types of grips for Cyriax deepTypes of grips for Cyriax deep friction massagefriction massage
  • 31. Pronosupination grasp: For more deeply situated lesions. Pronosupination grasp: For more deeply situated lesions.
  • 32. Pincer Grasp: Usually for trigger points. Pincer Grasp: Usually for trigger points.
  • 33. Pulp of Thumb: For flat surfaces, taut bands, nodules in flat surfaces Pulp of Thumb: For flat surfaces, taut bands, nodules in flat surfaces
  • 34. PercussionPercussion Percussion manipulations are those the treated part is struck softPercussion manipulations are those the treated part is struck soft blows with the hand.blows with the hand.  Whole hand contact/finger tip contact can be used.Whole hand contact/finger tip contact can be used.  Six types:Six types: A.A. Hacking: skin is struck using the back of the tip of three medialHacking: skin is struck using the back of the tip of three medial fingersfingers B.B. Clapping: whole palmar aspect is used to strike the body part (makeClapping: whole palmar aspect is used to strike the body part (make sure the hand is cupped slightly)sure the hand is cupped slightly) C.C. Vibration: involves a movement in which tissues are pressed andVibration: involves a movement in which tissues are pressed and released using an up and down motionreleased using an up and down motion D.D. Beating: dorsal aspect of middle phalanx of loosely clenched fistBeating: dorsal aspect of middle phalanx of loosely clenched fist (with thumb inside the fist) is used for the strike(with thumb inside the fist) is used for the strike E.E. Pounding: ulnar aspect of loosely clenched fist is used to strikePounding: ulnar aspect of loosely clenched fist is used to strike F.F. Tapping: with the tips of finger pads on a smaller are such as face;Tapping: with the tips of finger pads on a smaller are such as face; index, ring and middle finger may be used together or in a singlyindex, ring and middle finger may be used together or in a singly sequence.sequence.
  • 35.  HackingHacking  ClappingClapping  VibrationVibration  BeatingBeating
  • 37. IndicationsIndications 1.1. For tensed musclesFor tensed muscles 2.2. Muscular painMuscular pain 3.3. Tight musclesTight muscles 4.4. Blocked sinusBlocked sinus 5.5. Flaccid musclesFlaccid muscles 6.6. For relaxationFor relaxation 7.7. For scarsFor scars ContraindicationsContraindications 1.1. Local cancerousLocal cancerous lesionlesion 2.2. Open woundOpen wound 3.3. Skin allergiesSkin allergies 4.4. Deep veinDeep vein thromobosisthromobosis 5.5. Skin infectionSkin infection 6.6. Operative conditionsOperative conditions with implantswith implants