MASSAGE 2

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MASSAGE 2

• CLASSIFICATION AND Description of massage
  strokes.
• MECHANICAL, PHYSIOLOGICAL AND THERAPEUTIC EFFECTS

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GOALS

• 1.Demonstrate the knowledge and ability to
  describe and apply massage strokes.
• 2. Discuss the effects of different massage
  strokes
• 3. Explain the therapeutic uses of massage.
• 4. Express a working knowledge of the
  contraindications for massage.
• 5. Recognize the importance of performing basic
  screening procedures for integumentary
  integrity,pain, m performance and flexibility,
  jt. Integrity and mobility, prior to the
  application of massage.
• 6. Document appropriately.

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Strokes

• You will be responsible for the following
  strokes
• A. stroking
• B. effleurage
• C. petrissage kneading, picking up, wringing,
  skin rolling
• D. tapotement
• E. vibration and shaking
• F. deep friction

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Classification of strokes

• 1. Stroking
• 2. Effleurage
• 3. Petrissage ( pressure)
• 4. Tapotement (percussion)
• 5. Vibration
• 6. Shaking
• 7. Deep friction

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Stroking

• Purpose begin massage. Get the feel of the
  patient. Help pt. To relax.
• Technique usually in one direction at a time
  and is done usually in line with the long axis of
  the limb or body. Hands more together or
  alternately, movement should be smooth and
  constant to establish a rhythm.
• Rate Slow to relax, fast to stimulate.
• Depth and pressure superficial slow gentle but
  firm. Very relaxing for pt. Deepinc. Pressure
  slowly. Generally used to stimulate circ to
  deeper structure. In direction to facilitate
  lymph drainage.

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stroking

• Effects occur through the mechanical impact on
  the tissues and reflexly thru sensory nerves.
• Produces relaxation? dec pain?dec spasm
• Faster ? stimulates sensory nerves endings to
  invigorate
• Deeper may cause dilatation of arterioles

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Stroking therapeutic uses

• Accustom pt to touch
• Gain info re tissues
• Help relieve m spasm ? dec pain
• Promotes relaxation
• Examples 1. Branching tree 2. Layering
• 3. Shingling 4. Three stroke traps

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Contraindications

• Large open areas
• Gross edema if the skin is compromised
• Marked varicosities
• Hyperesthesia
• If pt very hairy

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Effleurage

• Purpose facilitate circulation by moving
  contents in the superficial vein and lymph. Used
  to finish massage sequence to milk area below
  deeper strokes.
• Technique and direction Always in direction of
  return of fluid(towards heart). Use one or two
  hands simultaneously or alternating. Smooth,
  rhythmic, I nthe direction of the lymph glands
• Rate Perfromed slowly 7/sec

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effleurage

• Depth and pressure should be comfortable and
  deep enough to affect the veins. Pressure is
  gradually increased to facilitate the flow.
  Slight pause at end of stroke to allow valves to
  close to minimize back flow.
• Effects Mechanical pushing of blood back toward
  the heart.
• Accelerated lymph flow. This removes waste
  products to enhance healing. Relieves cap.
  Congestion that will enhance circ. Stim healing
• Increases mobility of superfical soft tissues

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Effleurage

• Therapeutic uses
• Accustoms pt PT
• Joins together other massage strokes
• F/u deeper strokes to milk tissues
• Inc. circ
• Promotes absorption of inflammatory exudate
• Relieves pain and promotes relaxation

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effleurage

• Contraindication
• Large open areas
• Gross edema
• Hyperesthesia
• Very hairy
• Chronic swelling in LE associated with CHF orRF

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Petrissage

• 4 Types
• 1.Kneading with 2 hands
• 2.Picking up
• 3.Wringing
• 4.Skin rolling

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Kneading

• There is alternating compression and release of m
  and tissues in a circular direction. This stroke
  has a very strong mechanical reaction on deep
  tissues
• Purpose mobilize m fibers for proper function.
  There are different types of kneading
  compression, squeeze, finger pad, knuckling

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Petrissage?picking up

• In this stroke one or more muscles are graped,
  lifted away from underlying tissue, squeezed and
  released in a circular manner. This is one
  handed petrissage.
• Purpose is to inc. m mobility
• Rate and rhythm slow, cont, rhymic. Treat from
  origin to insertion

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Pertissage? wringing

• Tissues are lifted with both hands and compressed
  alternately between fingers and thumbs of
  opposite hand
• Purpose mobilize m. Used mostly on large and
  loose m groups.

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Petrissage? skin rolling

• Skin and subcutaneous tissues are rolled over the
  deeper structures to mobilize those tissues.
• Rate 4-6/sec
• Difficult if the skin is tight or very fat. Pt
  may then perceive undesireable pinching.

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Effects of Petrissage
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PETRISSAGE

• INDICATIONS/USES
• INC. CIRC
• MOBILIZE M CONTRACTURES
• MOBILIZE TISSUES AND SKIN
• DEC CHRONIC EDEMA
• PAIN RELIEF
• DEC M FATIQUE
• PROMOTE RELAXATION

• CONTRAINDICATIO
• ACUTE M TEARS
• ACUTELY IMFLAMMED JOINTS
• SKIN DISEASE
• DAMAGE OR DISEASE OF BV PHLEBITIS / DVT
• HYPER/HYPOTONIICITY
• MALIGNANCY IN AREA
• INFECTIONS IN AREA

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TAPOTEMENT

• PURPOSE stimulate tissues.
• Types
• Clapping (cupping)
• Beating (pounding)
• Hacking
• EFFECTS Mechanical- loosens secretions,
  Reflex.- stretches m facilitating
  contraction. Stimulates mechanoreceptors which
  may dec pain.

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Tapotement therapeutic uses

• 1. Chronic chest conditions
• 2. General stimulating effect
• 3. To relieve neuralgia following amputation, or
  other trauma

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Tapotement Contraindications

• Rib fx-if working over the thorax
• Acute heart failure
• Acute PE
• Severe HTN
• Hyperesthesia
• Flaccid 2ary to chance of overstretching m
• Spasticity may inc
• Newly formed scar
• Acute traumatic edema
• Cancer or TB in area

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Vibration and Shaking

• Shaking is more course than vibration
• Purpose help loosen secretions in the lungs
• Effects Mechanical loosens adherent mucous.
  Inc. movement of gases in stomach. Reflex May
  relieve pain. Facilitate stretch reflex
• Therapeutic Uses chronic chest cond./post op

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Deep Friction

• Purpose to affect the CT of tendons, ligs, and
  m. Small, local, ddeply penetrating movements
  performed in a circular or transverse direction.
  Designed to mobilize tendons, ligs, jt. Capsules
  and m tissue.
• Use NO lubricant because you need firm contact

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Performing Transverse friction

• A.perform across the m fibers
• 1. Need the exactly correct spot
• 2. Place structure on a full stretch
• 3. Fingers move with the skin and subcutaneous
  tissues on the deeper ones. NO SLIDING
• 4. Use transverse motion across the fiber as this
  is the most effective way to mobilize striated m.
• 5. Sufficient depth and sweep to reach lesion

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Circular friction

• Perform with the fingertips or thumb in a
  circular motion. Gradually increase the degree
  of pressure. NO SLIDING
• Effects Release of histamine occurs that causes
  vasodilatation or controlled inflammation while
  mobilizing structures

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FRICTION

• THERAPEUTIC USES
• RELEASE SCAR TISSUE
• REORGANIZE SCAR
• M TEARS, MT LESIONS, TNEDONITIS, TENOSYN, SPRAIN

• CONTRAINDICATION
• ACUTE M TEARS
• ACUTELY INFLAMMED JTS.
• SKIN DISEASES
• DAMAGED OR DISEASED bv
• NEOPLASM OR TB
• BACTERIAL INFECTIONS

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Effects of Massage

• Soft tissue massage has 3 basic effects
• 1. Mechanical
• 2. Physiological
• 3. Psychological

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Mechanical Effects

• Depends on technique used. In addition
  mechanical effects may give rise to physiological
  effects.
• Movement of lymph, venous blood, lung
  secretions,edema, intestional contents,hematoma
  contents.
• Mobilization of m fibers, m masses, tendons,
  tendon in sheaths, skin and subcut tissue, scar
  tissue adhesions.

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Physiological

• A. BL and lymph flow- Inc by direct compression
  of vein to stimulate flow, elevation of body part
  also has a significant effect. Inc. hemoglobin
  and RBC values in blood. Increases o2 capacity
• B. Metabolism and Healing Inc urine output. No
  effect on O2 consumption, HR or BP. No large
  effect on genl metabolism

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Physiological muscle cont

• Normal m No change in tone, but is relaxing.
  No change in strength. Assists in recovery from
  fatique making it possible to do more exercise
• Prior to exercise massage assists the m become
  more flex and efficient by inc. m temp
• After exercise massage helps to dec soreness by
  removing lactic acid and other waste products
• Massage can facilitate m contraction by directly
  stimulating stretch reflexes before activity

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Physiological effects on pathologic m

• Does not prevent atrophy, but enables the m to
  return to normal quicker following reinnervation
  b/c of dec. fibrosis.
• Less tendency toward the development of
  contractures 2ry to breakdown of adhesions and
  maintenance of elasticity

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Bones and Joints

• Provides increased circulation to area which
  assists the healing process and callous formation
  at the fracture site. To date, there is no study
  to indicate that massage helps heal bone.
• Deep friction can help to break up adhesions of
  chronic jt. problems

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Nervous System

• Massage has no effect on regeneration rates
• Sedative effect
• Faster massage is stimulating
• Dec the sensitivity of n endings (amputees)

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Pain

• Any rubbing of the skin stimulates
  mechanoreceptors.Gait theory
• Releases endogenous opiates to decrease pain
• Helps clear kinines from area(pain metabolites)
• Breaks up the pain?spasm cycle

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Lungs/Respiration

• Decreased resp rate with relaxation massage.
• Loosens secretions
• Stim massage can inc resp rate

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Skin

• Reflex dilatation of cap?reddening and warmth are
  mechanical effects
• Cleansing effect?removal of superficial epidermis
• Loosened subcut tissue. Opens sebaceous glands
  2ary to inc circ and loosen adhesions. Inc skin
  pliability. Cocoa butter will soften scars

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Fatty tisssue

• No effect

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Psychological effects

• 1. Physical relaxation makes it easier for the
  pt. To let go.
• 2. Relief of anxiety and tension
• 3. Pain relief
• 4. Sexual arousal as much as possible avoid the
  areas of the genitals, buttocks, inside upper
  thighs, breasts, neck, only do face if necessary.
• 5. Wellness- dec stress, tension, pain relief

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Therapeutic effects

• Occur because of the mechanical, psychological
  and physiologic effects. Each stroke can be used
  to appropriately address impairments.

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General Therapeutic Uses
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Contraindications