Massage Therapy

1
Massage Therapy
2
History of Massage

• Natural reaction to when the body hurts is to rub
  it
• Dates back to at least the ancient Olympics
• In Europe in the Middle Ages, the Church of Rome
  its religious teachings discouraged massage as
  a healing practice
• Massage is derived from 2 sources
• Arabic verb mass to touch
• Greek word massein to knead
• Egyptians, Romans, Japanese, Persians, Chinese
  were known to practice massage therapy

3
History of Massage

• Sweden early 19th century, Peter Ling
  (acknowledged founder of curative gymnastics)
  appears to be founder of modern day massage
  techniques, incorporated with French massage
  techniques
• Techniques have changed dramatically in the past
  50 years
• Based on research by Albert Hoffa (1859-1907),
  James Mennell 1880-1957), Gertrude Beard
  (1887-1971).
• Scientific basis to massage was added
• Late 1980s, Amer. Massage Therapy Association
  was organized (1992 Natl Cert. Exam. For
  Therapeutic Massage Bodywork was formed)

4
What is Massage Therapy?

• Mechanical modality
• Used to manipulate the bodys tissue
• Effective in promoting local systemic
  relaxation, increasing local b. flow, breaking
  down adhesions, encouraging venous return
• Act of rubbing, kneading, or stroking the
  superficial parts of the body with the hand or an
  instrument for the purpose of modifying
  nutrition, restoring power of movement or
  breaking up adhesions
• Time-consuming

5
Treatment Considerations Guidelines

• Need to know underlying pathology
• Need to know basic massage principles (must have
  manual dexterity, coordination, concentration).
  Must also exhibit patience courteousness.
• Hands must be clean, warm, dry soft. Nails
  must be short and smooth. Hands should be warm.
• Avoid constant hyperextension or hyperflexion of
  any joints which may lead to hypermobility.
• Must obtain correct positioning that will allow
  for relaxation, prevent fatigue permit free
  movement of arms, hands, body.

6
Treatment Considerations Guidelines

• Must obtain good posture to prevent fatigue
  backache.
• Weight should be evenly distributed on both feet.
• You must be able to fit your hands to the contour
  of the area being treated.
• A good position is required to allow for correct
  application of pressure and rhythmic strokes
  during the procedure.

7
Points for Consideration

• Pressure regulation should be determined by the
  type amount of tissue present. Also, pressure
  is governed by the condition which tissues are
  affected.
• Each stroke must have equal pressure time
  (rhythm present).
• Duration depends on pathology, size of area,
  speed of motion, age, size, condition of
  athlete. Also, massage may not be warranted on a
  daily basis (e.g. friction massage).
• Some areas may take 30 minutes.

8
Points for Consideration

• If swelling is present in an extremity, treatment
  should begin proximally.
• Uncorking the bottle, uncorking effect
• Massage should never be painful, except possibly
  for friction massage. It should not cause
  ecchymosis.
• Direction of forces should be applied in the
  direction of the muscle fibers.
• Each session should begin end with effleurage.

9
Points for Consideration

• Make sure the patient is warm and in a
  comfortable, relaxed position. Also, make sure
  the patient is properly draped.
• The body part may be elevated if necessary.
• Massage should begin with superficial stroking.
• Each stroke should start at the joint or just
  below the joint (unless contraindicated) and
  finish above the joint so that strokes overlap.
• Pressure should be in line with venous flow.
• Bony prominences painful joints should be
  avoided if possible.

10
Massage Media

• Used to decrease friction between the patients
  skin and the clinicians hand
• Massage can be given without any medium being
  used
• Lotions, peanut oil, powder, analgesic balms
• More medium should be used on
• hairy areas
• During petrissage lubricants
• interfere with the kneading lifting
• During friction massage
• lubricants may interfere with
• the certain results you want to
• obtain

11
Massage Strokes

• Effleurage
• Petrissage
• Friction (circular, transverse)
• Tapotement
• Vibration
• Myofascial release techniques
• Various other forms some may combine strokes

12
Physiological Effects of Massage Therapy

• Depending on the amount of pressure applied the
  speed of the stroke, many results can occur
• Light, slow stroking evokes systemic relaxation
• Fast, deep strokes increase blood flow to the
  area
• Cardiovascular changes deep friction or
  vigorous massage was thought to produce vascular
  changes
• Research failed to support those theories
• No increase in cardiac output, b.p., or increased
  arterial b. flow were revealed
• Massage can produce decreased heart rate,
  breathing rate, b.p. if the purpose is for
  inducing system relaxation

13
Physiological Effects

• Petrissage has been shown to decrease
  neuromuscular excitability, but only during the
  massage (effects confined to muscle being
  massaged)
• Deep effleurage, circular transverse friction
  has shown to improve flexibility
• Massage is less effective in decreasing muscular
  recovery time, but may be effective (2 hrs post)
  in reducing amount of DOMS
• Little reduction in m. fatigue when performing
  between exercise (pitcher, sprinter)

14
Physiological Effects

• Edema reduction when performed properly it can
  increase venous lymphatic flow
• Reduces pain
• By decreasing pressure from swelling, mechanical
  pain can be reduced
• By interrupting m. spasm, mechanical pain can be
  reduced
• By reducing edema, mechanical pain can be reduced
• By increasing b. flow encouraging waste
  removal, chemical pain can be reduced
• Activates sensory nerves inhibits pain

15
Mechanical Effects

• Techniques that stretch a muscle, elongate
  fascia, or mobilize soft-tissue adhesions or
  restrictions are all mechanical techniques
• Mechanical effects are always accompanied by some
  reflex effects
• As mechanical stimulus becomes more effective,
  reflex stimulus becomes less effective
• Muscle massage is done either for mechanical
  stretching or to relieve pain associated with
  trigger points

16
Mechanical Effects

• Skin massage has been shown to increase skin
  temperature, increase sweating decrease
  resistance to electrical current
• It has been shown to toughen yet soften the skin
• Acts directly on the surface of the skin to
  remove dead cells
• Stretches breaks down fibrous tissue

17
Psychological Effects

• One-on-One treatment
• Reduces patient anxiety, depression, mental
  stress
• Patient compliance is increased
• Patient gains confidence in clinician

18
Effleurage

• Stroking of the skin
• Performed with palm of hand
• Stimulates deep tissues
• Performed with fingertips
• Stimulates sensory nerves
• Superficial, rhythmic stroking
• Contours the body or relates to direction of
  underlying muscles
• Deep stroking
• Follows course of veins lymph vessels

19
Effleurage

• May be performed slowly for relaxation or rapidly
  to encourage blood flow stimulate the tissues
• Performed in rhythmic manner
• One hand should always be in contact w/ skin
• Light effleurage is performed at beginning end
  of massage or may be used between petrissage
  strokes
• At beginning relaxes patient indicates area
  to be treated
• At end calms down any irritated areas

20
Petrissage

• Lifting kneading of skin, subcutaneous tissue,
  muscles
• Performed with fingers or hand
• Skin is gently lifted between thumb fingers or
  fingers palm gently rolled kneaded in the
  hand
• Often performed without lotion
• Frees adhesions by stretching separating muscle
  fiber, fascia, scar tissue while assisting with
  venous return milking out waste products

21
Friction

• Goal is to mobilize muscle separate adhesions
  that restrict movement cause pain
• Facilitates local blood profusion
• Not necessarily a pleasing treatment
• Circular
• Applied with thumbs working in circular motion
• Effective in treating muscle spasm trigger pts.

22
Friction

• Transverse
• Applied with thumbs or fingertips stroking the
  tissue from opposite directions
• Can use elbow, end of rolling pin, etc. for
  larger areas
• Reaches deep tissues
• Begin lightly and then move to firmer strokes
• Muscle should be placed in relaxed position
• Should be avoided in acute conditions
• Effective in tendonitis or other joint adhesions

23
Tapotement

• Gentle tapping or pounding of the skin
• Most common form uses ulnar side of wrist to
  contact skin karate chop
• Wrist fingers are usually limp, alternate
  method cups the hand
• Promotes relaxation densitization of irritated
  nerve endings

24
Vibration

• Rapid shaking of the tissues
• Soothes peripheral nerves
• A mechanical device can be used

25
Myofascial Release

• Involves effleurage, petrissage friction
  massage strokes with stretching of muscles
  fascia
• Tries to obtain relaxation of tense and/or
  adhered tissues (myo muscle fascia band
  ease the tension of fibrous CT bands)
• No structured pattern
• Involves pulling of tissues in opposite
  directions, stabilizing the proximal/superior
  position w/ one hand while applying a stretch w/
  opposite hand, or using the patients body weight
  to stabilize the extremity while a longitudinal
  stress is applied
• Can involve more than one clinician

26
Myofascial Release

• Purpose is to relieve soft tissue from abnormal
  grip of tight fascia
• May also be known as soft-tissue mobilization
• Treatment is based on localizing the restriction
  moving into the direction of the restriction
• Very subjective relies on experience of
  clinician
• Recommended to treat at least 3 x per week

27
Acupressure

• Acupressure based on Chinese art of Acupuncture
• The Chinese make no distinction between arteries,
  veins, or nerves when explaining function of the
  body.
• Concentrate on the system of forces that regulate
  all bodily functions.
• Qi (pronounced che exists in everyone
  controls all aspects of life)
• Qi is governed by two opposing forces, Yang
  (positive) Yin (negative) forces. Disease
  results from some imbalance between these two
  forces.
• Yin Yang pass flow through passageways/lines in
  the body called jing (Chinese) or meridians
  (West).

28
Acupressure

• Lung (L)
• Large Intestine (LI)
• Stomach (ST)
• Spleen (SP)
• Heart (H)
• Small Intestine (SI)
• Urinary bladder (UB)
• Kidney (K)
• Pericardium (P)
• Triple warmet (TW)
• Gall bladder (GB)
• Liver (LIV)
• Governing vessel (VB)
• Conception vessel (CV)

• 12 meridians in the body named according to the
  part of the body with which they are associated.
  The meridians on one side of the body are
  duplicated on the other side however, two
  additional meridians exist that cant be paired.
• not paired

29
Acupressure

• Along the meridians lie the acupuncture points
• Whenever there is pain or illness, certain points
  on the surface of the body become tender
• When pain is eliminated, these tender spots
  disappear
• According to acupuncture theory, stimulation of
  specific points through needling can reduce pain
  in areas associated with a particular point
• Thousands of points have been identified

30
Acupressure

• Electrical resistance of the skin at certain
  points corresponding to the acupuncture points is
  lower than that of surrounding skin, especially
  when a disease state is present.
• Russian research has shown evidence of skin
  temperature difference at these points.

31
Myofascial Trigger Points

• Trigger points are the counterpart of acupuncture
  points
• May be found in muscle, tendons, myofascia,
  ligaments capsules surrounding joints, in
  periosteum, in the skin
• May activate become painful due to trauma
• Stimulation of these points have resulted in pain
  relief

32
What to do.

• Location of points Use an ohmmeter to
  differentiate the electrical impedance of areas
  OR palpate the area until either a small fibrous
  nodule or strip of tense muscle tissue that is
  tender to the touch is felt.
• Once located, massage is begun using the thumb,
  index or middle fingers or the elbow.
• Perform small friction-like circular motions over
  the point.
• Amount of pressure should be determined by
  patient tolerance, and may be intense and
  painful.
• Treatment time 1-5 minutes at a single point.
• Patient will report a dulling/numbing effect
  will report the pain diminishes.

33
Rolfing

• May also see it is structural integration
• Goal - to balance the body within a gravitational
  field through a technique involving manual
  soft-tissue manipulation
• Improve balance, posture, flexibility, movement
  efficiency
• Basic principle of treatment is - if balanced
  movement is essential at a particular joint, yet
  nearby tissue is restrained, both the tissue
  the joint will relocate to a position that
  accomplishes a more appropriate equilibrium.

34
Rolfing

• Standardized approach that is administered
  without regard to symptoms or pathologies
• Technique involves 10 hour-long sessions, each
  emphasizing some aspect of posture
• 10 sessions include
• Respiration, balance under the body (legs/feet),
  sagittal plane balance (lateral line from front
  to back), balance left to right (base of body to
  midline), pelvic balance (rectus abdominis
  psoas), weight transfer from head to feet
  sacrum, relationship of head to rest of body,
  upper ½ of body to lower ½ of body relationship,
  balance throughout the system
• Additional tune-up sessions may be required
• Integrates structural with psychological approach

35
References

• Images
• http//www.google.com