The document provides an overview of therapeutic massage, including its historical origins dating back to ancient Olympians, purposes of manipulating tissues to reduce muscle spasm and improve blood flow, and common techniques like effleurage, petrissage, friction, tapotement, and vibration. It also describes myofascial release techniques like J-strokes and skin rolling. The physiological effects of massage are discussed as well as common indications, contraindications, and preparation steps. Traditional and edema reduction massage protocols are outlined.

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Therapeutic Massage

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Historical Perspective
• Dating back to the ancient Olympians
• Late 1980’s
– American Massage Therapy
• 1992
– National Certification Examination for
Therapeutic Massage and Bodywork

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Purpose
• Manipulates the the body’s tissues to:
– Reduce muscle spasm
– Promote relaxation
– Improve blood flow
– Increase venous drainage
• Broad range of massage theories, techniques,
and effects

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• Basic Strokes:
• Effleurage
• Pétrissage
• Friction
• Tapotement
• Vibration
• Myofascial Release:
• J-Strokes
• Focused Stretching
• Skin Rolling
• Arm Pull / Leg Pull
• Diagonal Release
Types of Massage

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Effleurage
• “Stroking of the skin”
• Spread massage lubricant
• Use at the beginning and end of the massage
• Superficial:
– slow strokes for relaxation
• Deep:
– Elongates muscle fibers
– Stretches fascia
– Forces fluids in the direction of the stroke
• towards the heart

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Pétrissage
• “Lifting and kneading”
• Frees adhesions:
– Stretches and separates muscle fiber, fascia, and
scar tissue
• If only technique used, it may be performed
without the use of lubricant

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Friction
• “Deep pressure”
• Circular:
– Use a circular motion with thumbs, elbow, or a
commercial device
• Transverse Friction:
– The thumbs or fingertips stroke in opposite
directions
• Effects muscle mobilization, tissue
separation, and trigger points

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Tapotement
• “Tapping or pounding” of the skin
• Variations:
– Hacking
– Cupping
– Pincement (pinching)
– Rapping
– Tapping
• Performed with a light, fast tempo
• Promotes muscular and systemic relaxation and
desensitization of irritated nerve endings

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Vibration
• “Rapid Shaking”
• Increases blood flow and provides systemic
invigoration of tissues
• Mechanical devices available

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Myofascial Release
• Stroking and stretching of tissues:
– Relax tense tissues
– Release adhered tissues
– Restore tissue mobility
• Clinician receives cues and feedback from the
patient’s tissue
– This indicates the appropriate strokes and stretches
• Specialized training in myofascial release
techniques is needed to become proficient in these
skills

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J-Strokes
• One hand places the adhesion on stretch
• Other hand’s 2nd
and 3rd
fingers stroke in the
opposite direction forming a ‘J’
• Mobilize scar tissue

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Focused Stretching
• Heel of one hand in the area of restriction
• Heel of other hand crossed in front
• Stretch the tissue using slow, deep pressure
• Reduces superficial or deep adhesions

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Skin Rolling
• Use fingers and thumb to lift and separate the
skin from the underlying tissue
– Similar to Pétrissage
• Roll skin between fingers noting restriction
• Lift skin and move it in the direction of the
restriction
• Reduces superficial myofascial adhesions

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Arm Pull/Leg Pull
• Arm pull (example):
• Grasp extremity proximal to wrist
• Apply gentle traction that is in line with
anterior deltoid
• Continue to abduct 10-15 degrees until full
abduction is reached
• Stretches large areas of fascia

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Diagonal Release
• One clinician grasps the leg proximal to
talocrural joint
• Other grasps the opposite arm proximal to
wrist
• Keep extremities horizontal to each other
• One moves the limb until adhesions are felt
while the other stabilizes the extremity
• Stretch large area of fascia

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Physiological Effects
• Cardiovascular
– Increase blood flow, histamine release, and temperature
– Decreased heart rate, respiratory rate, and blood pressure
• Neuromuscular
– Increase flexibility, decrease neuromuscular excitability
(relaxation), edema reduction, and stretch muscle and scar
tissue
• Pain
– Activate spinal gate and the release of endogenous opiates
• Psychological
– Reduces patient anxiety, depression, and mental stress

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

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Contraindications
• Acute inflammatory conditions
• Severe varicose veins
• Open wounds
• Skin infections
• Failed or incomplete fracture healing
• Thrombophlebitis

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Preparation
• Table
• Linens and pillows
• Massage lubricant
• Patient position
• Masseuse position

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Traditional Massage
• Apply massage medium with light, slow
• Build to deeper effleurage
• Pétrissage
• Wipe medium before applying deep friction
(if applicable)
• Reapply pétrissage and deep effleurage
• End with light effleurage

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Edema Reduction Massage

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Preparation
• Elevate the body area
• Apply massage lubricant to the skin
• Clinician is positioned distal to the extremity

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Stroke Sequence
• Begin proximal to the edematous area
• Long, slow, deep strokes towards the torso
• Move starting point slightly distal every
fourth or fifth stroke
• When the starting point moves distal to the
edema, begin working back towards the
starting point

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Termination
• Remove medium
• If appropriate:
– Active range of motion exercises
– Compression wrap
• Encourage patient to drink water to assist in
flushing metabolic waste

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