MASSAGE THERAPY

ALEXI MAE O MOJICA,PTRP

History of Massage

 Natural reaction to when the body hurts is to rub it

 Dates back to at least the ancient Olympics
 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
What is Massage Therapy?
 Mechanical modality
 Used to manipulate the body’s 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
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.
Treatment Considerations &
Guidelines
 Must obtain good posture to prevent fatigue
& backache.
 A good position is required to allow for
correct application of pressure and rhythmic
strokes during the procedure.
Points for Consideration
 Each stroke must have equal pressure & time
(rhythm present).
 Duration depends on pathology, size of area,
speed of motion, age, size, & condition of
patient/ athlete. Also, massage may not be
warranted on a daily basis (e.g. friction
massage).
Points for Consideration
 Massage should never be painful, except
possibly for friction massage
 Direction of forces should be applied in the
direction of the muscle fibers.
 Each session should begin & end with
effleurage.
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.
 Bony prominences & painful joints should be
avoided if possible.
Massage Strokes

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

 One-on-One treatment
 Reduces patient anxiety, depression, &
mental stress
 Patient compliance is increased
 Patient gains confidence in clinician
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
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
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
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.
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
 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
Vibration

 Rapid shaking of the tissues

 Soothes peripheral nerves
 A mechanical device can be used
 Benefits of Vibration
 1. along the course of a nerve is helpful for
restoring and maintaining the functions of a
nerve and the muscles supplied by them,
thereby improving their nutrition.
 2. can be performed on the abdominal area to
aid digestion and relieve flatulence.
 3. over the thoracic area and chest is particularly
beneficial for respiratory problems.
 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 patient’s body weight to stabilize the
extremity while a longitudinal stress is applied
 Can involve more than one clinician
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
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