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Therapeutic Massage. Massage The act of rubbing, kneading, or stroking the superficial parts of the body with the hand or with an instrument. The act.

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Presentation on theme: "Therapeutic Massage. Massage The act of rubbing, kneading, or stroking the superficial parts of the body with the hand or with an instrument. The act."— Presentation transcript:

1 Therapeutic Massage

2 Massage The act of rubbing, kneading, or stroking the superficial parts of the body with the hand or with an instrument. The act of rubbing, kneading, or stroking the superficial parts of the body with the hand or with an instrument. Mechanical stimulation of the tissues by means of rhythmically applied pressure and stretching. Mechanical stimulation of the tissues by means of rhythmically applied pressure and stretching.

3 Massage Reflexive Effects Reflexive Effects Sedation is induced via slow, gentle, rhythmical motion in order to relieve tension, soothe, and relax musculature Sedation is induced via slow, gentle, rhythmical motion in order to relieve tension, soothe, and relax musculature Sensory receptors are Sensory receptors are stimulated in the skin and stimulated in the skin and superficial fascia superficial fascia

4 Massage Mechanical Effects Mechanical Effects Mechanical or histological changes in myofascial structures through direct superficial force: Mechanical or histological changes in myofascial structures through direct superficial force: Stretch muscle Stretch muscle Elongate Fascia Elongate Fascia Mobilize soft tissue adhesions Mobilize soft tissue adhesions Always accompanied by some reflexive effects Always accompanied by some reflexive effects As mechanical effects become more effective, reflexive effects become less effective As mechanical effects become more effective, reflexive effects become less effective Mechanical techniques are best performed after reflexive techniques Mechanical techniques are best performed after reflexive techniques

5 Massage Psychologic Effects Psychologic Effects General sedative effect General sedative effect Decrease tension and anxiety Decrease tension and anxiety elicit feelings of well-being elicit feelings of well-being “Hands on” effect helps patients feel as if someone is helping them “Hands on” effect helps patients feel as if someone is helping them

6 Massage Benefits Pain Control Gate Control Theory Gate Control Theory Cutaneous stimulation of large afferent nerve fibers blocks transmission of pain carried in competing small afferent nerve fibers Cutaneous stimulation of large afferent nerve fibers blocks transmission of pain carried in competing small afferent nerve fibers Release of endogenous opiates Release of endogenous opiates

7 Massage Benefits Circulation Light massage produces local dilation of lymphatic and capillary vessels Light massage produces local dilation of lymphatic and capillary vessels Heavier pressure produces longer lasting dilation Heavier pressure produces longer lasting dilation Blood flow increases, increasing the temperature of the tissue being treated Blood flow increases, increasing the temperature of the tissue being treated Lymphatic flow increases, increasing the removal of edema Lymphatic flow increases, increasing the removal of edema

8 Massage Benefits Metabolism Does not significantly alter general metabolism Does not significantly alter general metabolism Increased blood flow does generate: Increased blood flow does generate: Increased dispersion of waste products Increased dispersion of waste products Fresh blood and oxygen supply Fresh blood and oxygen supply Removal of lactic acid Removal of lactic acid

9 Massage Benefits Musculature Mechanical stretching Mechanical stretching Relieve Pain Relieve Pain Increase ROM in hamstrings Increase ROM in hamstrings Decrease neuromuscular excitability Decrease neuromuscular excitability Massage does not increase muscle strength, bulk, or tone Massage does not increase muscle strength, bulk, or tone

10 Massage Benefits Skin Increased skin temperature Increased skin temperature Loosens subcutaneous adhesions Loosens subcutaneous adhesions Stretches and breaks down fibrous scar tissue Stretches and breaks down fibrous scar tissue

11 Hoffa Massage Classical massage techniques that use a variety of superficial strokes that include: Classical massage techniques that use a variety of superficial strokes that include: Effleurage Effleurage Petrissage Petrissage Tapotement Tapotement Vibration Vibration

12 Effleurage A stoke that glides over the skin without attempting to move the deep muscle masses A stoke that glides over the skin without attempting to move the deep muscle masses Helps to accustom the patient to the contact of the clinician Helps to accustom the patient to the contact of the clinician Initial strokes distribute lubricant Initial strokes distribute lubricant Search for areas of muscle spasm and soreness with finger tips Search for areas of muscle spasm and soreness with finger tips Contact maintained at all times to enhance relaxation Contact maintained at all times to enhance relaxation Every massage begins and ends with this stroke, as well as in between other types of strokes Every massage begins and ends with this stroke, as well as in between other types of strokes

13 Effleurage The stroke should start at the periphery and work toward the heart The stroke should start at the periphery and work toward the heart

14 Effleurage Pressure is applied with the heel of the hand, fingers slightly bent, and thumbs spread Pressure is applied with the heel of the hand, fingers slightly bent, and thumbs spread

15 Petrissage Kneading manipulations that press and roll the muscles under the fingers or hand Kneading manipulations that press and roll the muscles under the fingers or hand No gliding motions over the skin No gliding motions over the skin Muscles are squeezed, lifted, and relaxed Muscles are squeezed, lifted, and relaxed Stroke moves from the distal to the proximal point of muscular attachment Stroke moves from the distal to the proximal point of muscular attachment Grasp parallel to or at right angles to muscular fibers Grasp parallel to or at right angles to muscular fibers

16 Petrissage

17 Petrissage Smaller muscles may be kneaded with one hand Smaller muscles may be kneaded with one hand

18 Petrissage Larger muscles, or muscular groups, will require the use of both hands Larger muscles, or muscular groups, will require the use of both hands

19 Tapotement Percussion massage using a series of brisk blows, administered with relaxed hands and following each other in rapid, alternating movements. Percussion massage using a series of brisk blows, administered with relaxed hands and following each other in rapid, alternating movements. Hacking, cupping, slapping, beating, tapping Hacking, cupping, slapping, beating, tapping

20 Tapotement Penetrating effect stimulates subcutaneous structures Penetrating effect stimulates subcutaneous structures Increases circulation for more active flow of blood Increases circulation for more active flow of blood Peripheral nerve ending are stimulated such that they convey impulses more strongly Peripheral nerve ending are stimulated such that they convey impulses more strongly

21 Tapotement Hacking Hacking Alternate striking of patient with the ulnar border of the hand Alternate striking of patient with the ulnar border of the hand

22 Tapotement Slapping Slapping Alternate slapping with fingers Alternate slapping with fingers

23 Tapotement Beating Beating Half-closed fist using the hypothenar eminence of the hand Half-closed fist using the hypothenar eminence of the hand

24 Tapotement Tapping Tapping Tips of the fingers Tips of the fingers

25 Tapotement Clapping/Cupping Clapping/Cupping Use fingers, thumb, and palm together to form a concave surface Use fingers, thumb, and palm together to form a concave surface Used primarily in postural drainage Used primarily in postural drainage

26 Massage Routine Individual massage strokes alone do not make a good massage Individual massage strokes alone do not make a good massage The form and progression of the massage depend on the individual requirements of the patient The form and progression of the massage depend on the individual requirements of the patient

27 Massage Routine Example massage progression: Example massage progression: Superficial stroking (effleurage) Superficial stroking (effleurage) Deep stroking (effleurage) Deep stroking (effleurage) Kneading (petrissage) Kneading (petrissage) Tapotement Tapotement Superficial stroking (effleurage) Superficial stroking (effleurage)

28 Friction Massage According to the area to be covered, this technique is performed by either the tips of the fingers, the thumb, or the heel of the hand According to the area to be covered, this technique is performed by either the tips of the fingers, the thumb, or the heel of the hand Make small circular movements that penetrate into the depth of the muscle Make small circular movements that penetrate into the depth of the muscle Move the tissues under the skin rather than moving the hands over the skin Move the tissues under the skin rather than moving the hands over the skin

29 Friction Massage

30 Loosen adherent fibrous tissue Loosen adherent fibrous tissue Reduce local muscular spasm Reduce local muscular spasm Provide deep pressure over trigger points to produce reflex effects Provide deep pressure over trigger points to produce reflex effects

31 Transverse Friction Massage Treatment for chronic tendon inflammations Treatment for chronic tendon inflammations Place the tendon to be treated on a light stretch Place the tendon to be treated on a light stretch Use the thumb or index finger to exert intense pressure in a direction perpendicular to the muscular fibers Use the thumb or index finger to exert intense pressure in a direction perpendicular to the muscular fibers

32 Transverse Friction Massage Massage performed every other day Massage performed every other day 7-10 minutes 7-10 minutes Explain to the patient before beginning the massage that it is a painful technique Explain to the patient before beginning the massage that it is a painful technique It may be beneficial to apply ice to the treatment area before beginning for analgesic effects It may be beneficial to apply ice to the treatment area before beginning for analgesic effects

33 Transverse Friction Massage

34 Myofascial Trigger Points Hyperirritable locus within a taut band of skeletal muscle, tendons, myofascia, ligaments, joint capsules, periosteum, and skin Hyperirritable locus within a taut band of skeletal muscle, tendons, myofascia, ligaments, joint capsules, periosteum, and skin Points may activate and become painful due to direct muscle trauma or overuse inflammation Points may activate and become painful due to direct muscle trauma or overuse inflammation

35 Myofascial Trigger Points This diagram shows an example of a myofascial trigger point and the referred pain patterns for one of the neck muscles. This diagram shows an example of a myofascial trigger point and the referred pain patterns for one of the hip muscles This diagram shows an example of a myofascial trigger point and the referred pain patterns for one of the neck muscles

36 Myofascial Trigger Points Pain from a particular point is usually referred to areas that follow a specific pattern Pain from a particular point is usually referred to areas that follow a specific pattern Stimulation of these points has been shown to relieve pain Stimulation of these points has been shown to relieve pain Referred pain is an important characteristic of trigger points, and differentiates them from tender points Referred pain is an important characteristic of trigger points, and differentiates them from tender points

37 Myofascial Trigger Points Latent Trigger Points Latent Trigger Points Does not cause spontaneous pain Does not cause spontaneous pain Can resist movement or cause muscular weakness Can resist movement or cause muscular weakness Pain originates from the point when pressure is applied directly over the point Pain originates from the point when pressure is applied directly over the point

38 Myofascial Trigger Points Active Trigger Point Active Trigger Point Causes pain at rest Causes pain at rest Tender to palpation with a referred pain pattern away from the trigger point Tender to palpation with a referred pain pattern away from the trigger point Pain described as spreading or radiating Pain described as spreading or radiating

39 Myofascial Trigger Points Identification of Active Trigger Points Identification of Active Trigger Points Palpation of a hypersensitive bundle or nodule of muscular fiber of harder than normal consistency Palpation of a hypersensitive bundle or nodule of muscular fiber of harder than normal consistency Palpation elicits pain directly over the affected area and a radiating pattern of pain Palpation elicits pain directly over the affected area and a radiating pattern of pain Contraction against resistance increases pain Contraction against resistance increases pain Firm pressure over the point elicits a “jump sign”, crying out, wincing or withdrawing Firm pressure over the point elicits a “jump sign”, crying out, wincing or withdrawing

40 Myofascial Release Technique used to relieve soft tissue from the abnormal grip of tight fascia Technique used to relieve soft tissue from the abnormal grip of tight fascia Once a myofascial restriction is located, the massage should be directly through the restriction Once a myofascial restriction is located, the massage should be directly through the restriction Progress from superficial tissue to deep tissue Progress from superficial tissue to deep tissue Treatment recommended 3 times per week Treatment recommended 3 times per week

41 Indications for Massage Muscular, tendon, and joint conditions Muscular, tendon, and joint conditions Adhesions Adhesions Muscle spasms Muscle spasms Myositis Myositis Tenosynovitis Tenosynovitis Postural strain of back Postural strain of back Bursitis Bursitis Fibrositis Fibrositis Tendinitis Tendinitis

42 Contraindications for Massage Arteriosclerosis Arteriosclerosis Thrombosis Thrombosis Embolism Embolism Severe varicose veins Severe varicose veins Acute phlebitis Acute phlebitis Celluitis Celluitis Synovitis Synovitis Abscesses Abscesses Skin injections Skin injections Cancers Cancers Pregnancy Pregnancy Acute inflammatory conditions of skin, joints, and soft tissue Acute inflammatory conditions of skin, joints, and soft tissue

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