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Therapeutic massage and myofascial mobilization

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1 Therapeutic massage and myofascial mobilization
Aila Nica J. Bandong, PTRP Instructor Department of Physical Therapy College of Allied Medical Professions

2 Learning objectives At the end of the lecture, the students should be able to: Discuss therapeutic massage and myofascial mobilization in terms of physiologic mechanism benefits for use indications, contraindications and precautions Discuss the basic techniques of therapeutic massage and its variants Enumerate the different techniques of myofascial mobilization Cite evidence on the effectiveness of therapeutic massage and myofascial mobilization in the given sample cases

3 M a s s a g e

4 What is massage? Massage is the therapeutic manipulation of the soft tissues of the body with a goal of normalization of those tissues. Also defined as hand motions practiced on the surface of a living body with a therapeutic goal.

5 Therapeutic effects of massage
mechanical Assist in venous and lymphatic flow Stretching of superficial tissue Loosen scar tissue physiologic Metabolism Venostasis Edema

6 Goals of massage Mobilize interstitial fluid Reduce or modify edema
Increase blood flow Decrease muscle soreness or stiffness Alleviate pain Prevent or eliminate adhesions Facilitate relaxation

7 Benefits of massage Relaxation Pain relief Reduction of edema
Increase ROM Metabolically prepare injured or involved muscles for exercise Encourage confidence of patient Evaluate patient’s soft tissues Prepare healthy muscles for strenuous sports activity Assist the body in recovering from the aftereffects of strenuous activity

8 indications Tense muscles Scar tissue Edema Pain

9 contraindications Malignancy Thrombi Atherosclerotic plaques
Infections Scars that are not fully healed Patients on anti- coagulants Calcified soft tissue Skin grafts Atrophic skin Chronic subluxation Pathologic conditions that could be spread along the skin, through the lymph or the blood. Area where there is bleeding Areas of acute inflammation Phlebitis

10 precautions Disorders of circulatory system
Areas with abnormal sensation Over recent surgery Joint replacements Immunocompromised patients In the presence of medications that may alter sensation, muscle tone, standard reflex reactions, cardiovascular function, kidney and liver function and personality

11 limitations Will not reduce obesity
Will not delay loss of muscle strength Will not hasten recovery of sensation after nerve injury

12 Massage variants Western variant Eastern variant
Effleurage or Stroking massage Petrissage or Kneadingg massage Tapotement or Percussion massage Friction or Deep friction massage Vibration Eastern variant Acupressure Reflexology and auriculotherapy Shiatsu Massage variants

13 effleurage Aka stroking massage
Therapist’s hands glide across the skin overlying the muscle being treated Superficial effleurage Deep effleurage

14 purposes Promote relaxation Note areas of spasm and tightness
Get the therapist’s hands from one problem area to another Accustoms the patient to the touch of the therapist The only technique that may be employed in instances of extreme soreness Deep effleurage will provide a passive stretch to given muscles or muscle groups

15 variations Knuckling Loose fist Single/double hand
Three-count stroking of the trapezius Horizontal stroking Single/double forearm

16 petrissage Aka kneading massage
Strokes that attempt to lift the muscle mass and wring or squeeze it gently Soft tissue is compressed between the hand or fingers of the therapist and gently squeezed as the hands move in a circular motion perpendicular to the direction of compression Applied vertically in relation to the tissues

17 purposes Remove waste products Assist venous return
Effective in decreasing hypertonicity Beneficial in mechanically softening the superficial fascia

18 variations Picking- up Pinching Rolling Wringing Fulling Milking
Fist kneading Digital kneading Alternating two-hand petrissage Two-finger petrissage One-hand petrissage Alternate one-hand petrissage

19 Friction Aka deep friction massage
Pressure of varying intensities is applied with the ball of the thumb or fingers Mechanical effect is the application of shear stresses to the underlying tissue specifically at the interfaces (dermis-fascia, fascia- muscle, muscle-bone, scar tissue-bone) Considered as the most important massage technique Generally performed for 30 seconds to 10 minutes No lubricant used

20 Purposes Massage into deep joint spaces or around bony prominences
Breakdown connective tissue and scar adhesions except deep fibrositis in muscle belly For pain reduction through mechanism of counterirritation and hyperstimulation analgesia

21 variations Cross-fiber technique Storm’s technique
Cyriax’s friction massage

22 tapotement Aka percussion massage
The skin and muscle are impacted with repetitive compressive blows by the hands

23 Purposes Used when stimulation is desired
Usually performed in athletes Can be done to prepare patient for stretching Used to loosen mucus in the lungs

24 variations Hacking Cupping Fist beating Beating over palm Slapping
Finger tapping

25 vibration A fine tremulous movement made by the hand or fingers placed firmly against a part Can be used better with electrical vibrator Follows the path of the nerve in treatment of peripheral neuritis

26 purposes Used for a soothing effect especially in peripheral neuritis
Can be used to relax antagonist muscle through reciprocal inhibition Break up monotony of massage Can be used to loosen consolidations in the lungs

27 Compression Vertical pressing downward that penetrate the subcutaneous layer Can be done using the thumb, heel of the hand, palm, fist, knuckles, forearm, elbow Therapist stays perpendicular with actual compression (~45 to 90 degrees to the body)

28 purposes Can be used to replace effleurage if gliding strokes can not be performed Used to tone the muscles Stimulates the muscle spindle

29 shaking Rocking Relaxes muscle groups or an entire limb
Warms and prepares the body for deeper bodywork Indicated for extremely tight muscles Rocking Soothing and rhythmic method used to calm an individual Up-and-down and side-to-die movement of the body

30 acupressure Massage forces are applied using the fingers on acupuncture points Localized finger pressure coupled by circular movements Pressure is increased until pressure becomes heavy then held constant

31 Reflexology and auriculotherapy
All parts of the body are believed to be mapped to different point on the foot (reflexology) or the ear (auriculotherapy) and massage of a point produces change in the structure mapped to that point.

32 shiatsu Shi (finger) and atsu (pressure Japanese form of acupuncture
Pressure is applied at specific points (meridians) Was first administered by blind clinicians

33 Massage variables Milieu Treatment variables Friction-reducing medium
Rhythm Rate Pressure Direction Area to be treated Duration Frequency Duration of the program

34 M y o f as c I al M O B I L Z A T n

35 Myofascial Release Theory
Fascia: three-dimensional web of connective tissue running continuously through the body and superficial to deep without any interruption Three layers: Superficial Deep Dural

36 Myofascial Release Theory
Functions of Fascia: Holds tissues together Separates structures to allow mobility Protection, nutrition, elimination, and metabolism Composition: Collagen Elastin Ground substance

37 Myofascial Release Theory
Fascial Restrictions Cause excessive pressures on pain sensitive areas as well as excessive tensile force on the neuromusculoskeletal sturctures Sets up the environment for poor cellular efficiency, necrosis, disease, pain , and dysfunction throughout the body Dysfunction along the deepest/dural fascia can have neurologic effects A restriction in one area may cause restrictions in other areas of the body

38 Myofascial Mobilization
Also known as trigger point therapy, myofascial release Since fascia has colloidal properties it can be manipulated and stretched by sustained by pressure Effect is loosening of fascia  release restrictions or barriers within the fascial layers  relieve symptoms and promote normal quality and quantity of motion

39 Myofascial release A whole-body “hands-on” approach to evaluation and treatment of the human structure Evaluation of fascial system Intervention Re-evaluation Incorporated in a comprehensive program that includes modalities, therapeutic exercise, muscle energy techniques, mobilization and manipulation

40 indications Pain Movement restrictions Spasm Neurologic dysfunction
Sports injuries Chronic fatigue syndrome Fibromyalgia Pediatrics Scoliosis Menstrual, pelvic, temporomandibular pain Headache

41 Contraindications Malignancy Febrile state Acute circulatory condition
Aneurysm Acute rheumatoid arthritis Sutures Healing fracture Osteoporosis or advanced degenerative changes Systemic or localized infection Open wounds Anticoagulant therapy Advanced diabetes

42 Basic techniques Cross-hand techniques
Arm or leg pull (unilateral or bilateral) Cranial base release Skin rolling Scar release J-stroke

43 Thank you for listening!!!
Any questions?

44 references Brault, J. S., Kappler, R. E., Grogg, B. E. (2007). Manipulaiton, traction, and massage. In Braddom, R. L. (Ed) Physical medicine & rehabilitation. Philadelphia: Elsevier Inc. Cantu, R. I., Grodin, A. J. (1992). Myofascial manipulation: Theory and clinical application. Maryland: Aspen Publishers, Inc. de las Peñas, C.F., Campo, M.S., Carnero J.F. & Page, J.C.M. (2005). Manual therapies in myofascial trigger point treatment: a systematic review. Journal of Bodywork and Movement Therapies. Retrieved July 28, 2008 from 1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C &_v ersion=1&_urlVersion=0&_userid=10&md5=1a86d354ca36e2b5c7e9e62aed07dc37. Fritz, S. (2000). Fundamentals of therapeutic massage (2nd ed). USA: Mosby-yearbook, Inc. Gomez, M. Z. A. (2008). Lecture notes on massage and myofascial mobilization. UP- Manila College of Allied Medical Professions. Rechtien, J. J., Andary, M., Holmes, T., and Wieting, J. M. (1998). Manipulation, massage, and traction. In De Lisa, J., and Gans, B. Rehabilitation medicine: Principles and practice (Eds). Philadelphia: Lippincott-Raven Publishers. Rickards, L.D. (2007). The effectiveness of non-invasive treatments for active myofascial trigger point pain: A systematic review of the literature. International Journal of Osteopathic Medicine. Retrieved July 28, MK0N7B1&_coverDate=12%2F31%2F2006&_alid= &_rdoc=1&_fmt=&_orig=s earch&_qd=1&_cdi=25741&_sort=d&view=c&_acct=C &_version=1&_urlVer sion=0&_userid=10&md5=4f cc6bbc024dc953f16bdffb. Tappan, F. (1988). Healing massage techniques: Holistic, classic, and emerging methods (2nd ed). Connecticut: Appleton & Lange.

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