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 ( ), James Mennell ), & Gertrude Beard ( ).
Scientific basis to massage was added
Late 1980’s, Amer. Massage Therapy Association was organized (1992 – Nat’l Cert. Exam. For Therapeutic Massage & Bodywork was formed)

4. 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

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 patient’s skin and the clinician’s 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 patient’s 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 can’t 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
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