1. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins C HAPTER 13 Swedish Massage Techniques

2. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–1: E FFLEURAGE Effleurage: long, gliding stroke delivered with light, medium, deep pressure that follows direction of muscle fibers. Often first applied to a body area. Spread lubricant; warm muscles in anticipation of deeper work; assess general condition of client’s tissue. Applied toward heart. Connects massage of different body areas; provides flowing transition between techniques.

3. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–1: E FFLEURAGE Effects of Effleurage Vary depending on stroke’s depth, speed, direction. Activation of parasympathetic nervous system response important benefit of Swedish massage. Associated with rest-and-recover response. Helps body deal with stress, decreases symptoms associated with digestive upset, reduces pain.

4. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–1: E FFLEURAGE Effects of Effleurage Rubs off dead skin cells; creates pliability in skin. Encourages local circulation and lymph flow. Aids tissue recovery and reduces muscle soreness. Contraindicated for any condition generally contraindicated for massage and over open skin lesions or skin diseases.

5. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–1: E FFLEURAGE Application of Effleurage Palm of hand, fingertips, edge of hand, forearms, knuckles, thumbs used to apply effleurage strokes. Choice depends on desired depth and body area. See Technique 18: Effleurage.

6. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–1: E FFLEURAGE Application of Effleurage Undrape the area. Place moderate amount of lubricant in your hand. Warm lubricant; apply it to area in long stroke that begins at bottom of area (distal), travels to top of area (proximal), returns to bottom of area (distal) without losing contact with client.

7. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–1: E FFLEURAGE Application of Effleurage Have your hands open so that entire surface of palms and fingers contact client’s tissue. Feel fullness of tissue. Notice temperature or texture changes in tissue.

8. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–1: E FFLEURAGE Application of Effleurage Visualize direction of muscle fibers running under skin; imagine sinking your hands into that muscle. As tissue begins to warm up, increase depth of stroke. Never force your hands into unyielding tissue.

9. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–1: E FFLEURAGE Application of Effleurage Relax and drop into tissue using weight of your body rather than strength of your arm muscles or tense wrists. Pay attention to rhythm and speed of your stroke. As you slow down or speed up, client’s breathing pattern changes.

10. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–1: E FFLEURAGE Application of Effleurage Slow down; explore how slow you can make your stroke. Lighten pressure of stroke; explore how soft you can make stroke. Concentrate pressure of stroke; explore how deep you can sink into tissue.

11. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins C HAPTER 13 Swedish Massage Techniques

12. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–2: P ETRISSAGE Petrissage: rhythmic stroke that lifts muscle off bone and other muscles; compresses it between fingers; rolls muscle fibers as muscle falls back into position. Stimulate circulation in muscles. Make soft tissue more pliable. Break up adhered fibers.

13. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–2: P ETRISSAGE Effects of Petrissage Stimulates sebaceous secretion; conditions skin. Stimulates local circulation to warm soft tissue; improves nutrient and waste exchange. Decreases muscle tension. Decreases adhesions in soft-tissue structures.

14. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–2: P ETRISSAGE Effects of Petrissage Adhesions lead to decreased blood flow, decreased ROM, pain, decreased function in the area. When you run myofascial fibers through your fingers during petrissage stroke, stroke: Helps break up adhesive bonds. Makes tissue more pliable. Gives ground substance good stirring.

15. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–2: P ETRISSAGE Effects of Petrissage Skin rolling: lifts skin and superficial fascia away from underlying muscle; rolls it through fingertips. Reduces adhesions in superficial fascia. Should not be used on atrophied muscles that lack moderate tone. Not applied over open skin legions, skin diseases, bruises, acute injuries, inflammation, varicose veins.

16. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–2: P ETRISSAGE Application of Petrissage Wrap one hand around tissue, keeping your fingers together as unit. Lift muscle away from bone until you feel it stretch. Roll muscle through your fingers and out of your hand as your other hand lifts up another section of tissue.

17. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–2: P ETRISSAGE Application of Petrissage Too much lubricant prevents you from getting good hold on muscle; use little lubricant for this technique. Rhythmic, kneading action continued over entire body area. Often referred to as “milking” tissue of metabolic wastes because of increase in local circulation.

18. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–2: P ETRISSAGE Application of Petrissage How much lift and squeeze to use depends on body area where stroke applied. Be careful not to pinch client or pull on body hair during petrissage. If client complains that stroke is pinching, make sure that you lift enough tissue during stroke.

19. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–2: P ETRISSAGE Application of Petrissage To flush metabolic wastes released from tissue, apply effleurage strokes directly after petrissage. Pay attention to lift of tissue and its texture as it runs through your fingers.

20. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–2: P ETRISSAGE Application of Petrissage Differences in tissue tells you about health of myofascia; how much massage needed in particular area. Check with client frequently to ensure pressure of stroke comfortable. See Technique 19: Petrissage.

21. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins C HAPTER 13 Swedish Massage Techniques

22. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–3: F RICTION Friction: heat-producing, chafing stroke applied either with light, brisk strokes (superficial friction) or with depth (circular, linear, cross-fiber friction). Applied after petrissage, using little or no lubricant. Heat local tissue. Break up adhered tissue. Reorganize collagen fibers into parallel patterns allowing for greater ROM.

23. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–3: F RICTION Deep Linear Friction Strokes Addresses connective tissue. Superficial tissue pushed onto underlying structures; pulled over top of structures, stretching myofascia. Cyrix Cross-Fiber Friction Applied across fibers of muscle instead of following muscle fiber direction. Rapid and deep transverse rubbing creates inflammation in tissue.

24. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–3: F RICTION Cyrix Cross-Fiber Friction Stimulates tissue repair. Connective tissue reorganized; breakdown of scar tissue. Advanced technique; part of orthopedic massage, clinical massage, treatment massage.

25. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–3: F RICTION Effects of Friction Varies depending on stroke’s depth, direction, speed. Superficial friction is brisk and stimulating. Produces heat in skin from resistance between client’s body and therapist’s hands. Increases circulation and lymph flow to local tissue.

26. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–3: F RICTION Effects of Friction Deep friction applied parallel to muscle fibers to separate fibers so that they can more readily slide over each other and move freely. Myofascia stretched and broadened. Better flexibility and muscular balance.

27. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–3: F RICTION Effects of Friction Transverse friction applied across muscle fibers to break up an adhesion or scar tissue. Applied more slowly than Cyrix cross-fiber friction. Do not use friction strokes over open skin legions, skin diseases, bruises, acute injuries, inflammation, moderate to severe varicose veins.

28. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–3: F RICTION Application of Friction Superficial friction applied with palms in quick, light, back-and-forth motion with little or no lubricant. Fingertips, thumbs, knuckles, forearm, elbow, or edge of hand used to apply deep friction stroke.

29. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–3: F RICTION Application of Friction Pay attention to quality of client’s tissue and how it changes during treatment. Adhesions feel like stuck tissue glued together. Tissue may move freely and then suddenly grab. Obvious knots of bound-up tissue; client may report as area of mild numbness.

30. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–3: F RICTION Application of Friction Unhealthy or adhered tissue not easy to describe or identify. With experience, you will be able to quickly assess client’s tissue. See Technique: 20 Friction.

31. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins C HAPTER 13 Swedish Massage Techniques

32. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–4: V IBRATION Vibration: pulsating, tremor-like or oscillating stroke that stimulates or relaxes body area or whole body depending on how it is applied. Short bursts to particular area. Can be tiring for therapist. Shoulders, elbows, wrists must remain relaxed while hands vibrate rapidly. May be fine, coarse, rocking.

33. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–4: V IBRATION Effects of Vibration Depends on how stroke applied. Initially, vibration stimulating; startles body and briefly activates sympathetic nervous system. As stroke progresses, body relaxes. Sustained vibration to particular area has numbing, analgesic effect, reducing pain.

34. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–4: V IBRATION Effects of Vibration Fine vibration applied with fingertips on abdomen to stimulate peristalsis. Used on other delicate areas of body (face, to relax muscles).

35. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–4: V IBRATION Effects of Vibration Shaking: coarse vibration in which muscle group is lifted and shaken to confuse proprioceptors so that muscles relax.

36. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–4: V IBRATION Effects of Vibration Jostling: coarse vibration used to prevent muscle guarding of limb; encourage general relaxation. Shaking and jostling encourages synovial fluid production in join; aids joint fluidity and health.

37. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–4: V IBRATION Effects of Vibration Rocking: pushing and releasing area so that it sways back and forth. Soothes nervous system and relaxes muscle.

38. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–4: V IBRATION Effects of Vibration Very rapid vibration: stimulates muscle spindles to cause muscle contractions that tone muscle, warm tissue, increase circulation. Vibration should not be used over open skin legions, skin diseases, bruises, acute injuries, inflammation, varicose veins.

39. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–4: V IBRATION Application of Vibration Pay careful attention to your body mechanics when performing this stroke. Easy to tense your shoulders, elbows, wrists during fine vibration. Focus on relaxing shoulders and arms. Apply stroke omly for short periods of time to avoid fatigue.

40. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–4: V IBRATION Application of Vibration Watch, feel, listen, think about what you see, touch, and hear. Increased awareness will help you build palpation and assessment skills. See Technique 21: Vibration.

41. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins C HAPTER 13 Swedish Massage Techniques

42. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–5: T APOTEMENT Effects of Tapotement Rapid, rhythmic percussion stroke using hands in various formations to drum on client. Varies depending on speed, force, length of application. Short bursts of forceful tapotement stimulating to both local area and body as whole. Longer applications relax body area and body as whole.

43. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–5: T APOTEMENT Effects of Tapotement Very light tapotement with fingertips causes vasoconstriction of superficial capillaries. Moderate drumming applied with medial sides of hand causes vasodilation and increased circulation. Brief applications of light percussion help tone atrophied muscles. Long applications of moderate percussion help soothe areas of hypersensitivity.

44. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–5: T APOTEMENT Effects of Tapotement Should not be used directly after athletic activity; may cause muscles to cramp. Tapotement over kidneys and floating ribs contraindicated; may be damaged by stroke.

45. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–5: T APOTEMENT Effects of Tapotement Avoided on boney areas (especially spine) and over bruises and varicose veins. Check with client regularly to ensure strokes are comfortable.

46. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–5: T APOTEMENT Application of Tapotement Hold hands in different formations for different types of tapotement. Hacking uses ulnar side of hand. Cupping uses hands shaped like cup.

47. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–5: T APOTEMENT Application of Tapotement Hands held open in slapping. In pincement fingertips used to pick up small bits of superficial tissue. See Technique 22: Tapotement.

48. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–5: T APOTEMENT Application of Tapotement Applied to dry or oiled skin; even over drape. Often called percussive stroke; similar to drumming. Rhythm very important in delivery. Irregular strokes that suddenly speed up or slow down can feel irritating to client’s nervous system.

49. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–5: T APOTEMENT Application of Tapotement Move up and down and across body area fluidly. Avoid overtreating one area. Keep moving stroke.

50. Copyright © 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins T OPIC 13–5: T APOTEMENT Application of Tapotement Keep your wrists and fingers loose. Stiff wrists or fingers may hurt client or yourself. Practice on soft surface like pillow, with music, to improve your rhythm and regularity.