Massage

Massage is an ancient therapy. There is evidence that is was used in china more than 5000
years ago (McRee Noble, and pasvogel,2003), it is one of the most widely used complementary
thrapies and has been a part of the nurse’s armamentarium for centuries. At a time when the public
use of massage is inscreasing, the nursing profession is decreasing its use of this traditional
interventation. To compensate for this, some health institutions have massage therapists on staff:
patients or this service.

Massage is often combined with other therapies, such as music, aromatherapy, acupressure,
or light touch. Thus, it is difficult to differentiate the specific effects of massage from those of the
other therapies used. Study findings point to the positive effects of massage with or without other
therapies in producing relaxation, improving sleep, and reducing pain.

Definition

The term massage is derived from the arabic word mass’h, meaning “to press gently” (furlan,
brosseau, imamura, and irvin,2004). Massage, as defined by the american massage therapy
association, is “the application of manual techinques and adjuncitive therapies with the intention of
positively affecting the health and well-being of the client” . various strokes are used to produce
friction and pressure on cutaneous and subcutaneous tissues. The types of stroke and the body part
being massaged.

There are a enumber of types of massage : swedish ( a massage using long ,flowing strokes )
:esalen ( a meditative massage using light touch ) : deep tissue or neuromuskular ( an intense
kneding of the body ) : sports massage ( a varigous massage to loosen and ease sore muscles ) :
shiatshu a japanese pressure –point technique to relieve stress ) : and reflexology a deep foot
massage that relates to parts of the body ). The different types of massage incorporate a variety of
stroks, varying leves of pressure, and a multitude of procedures .massage strokes can be admin
istered to the entire body or to specific areas of the body ,such as the back,feet,or hands

Scientific basis

The use of massage is a natural healding process that helps to connect the body, mind, and
spirit.massage produces therapeutic effects on multiple body system.integumentary
,musculosceletal,cardiovaskuler , lymph,and nervous. Manipulating the skin and underliying muscle
makes the skin supple. Massage increases or enhances movement in the musculoskeletal system by
reducing swelling, loosening and stretching contracted tendons,and aiding in the reduction of soft-
tissue adhesions.friction to the cutaneous and subcutaneous tissue release histamines that in turn
produce vasodilation of vessels and enhance venous return.

Massage has been found to produce a relaxation response ( hattan, king & griffiths , 2002 : holland &
pokorny ,2001 :mc namara ,burnham ,smith, & carroll ,2003 ) .investigators report that massage has
produce a decrease in certain physiological parameters ( systolic and diastolic blood preasure ,heart
rate, and skin temperature ) , indicative of the relaxation respons ( mok & woo ,2004 )
Reduction of pain , a frequent desired outcome of massage ,is closely related to the production of
the relaxation response . studies have validate that petiens were more more comfortable after the
administration of massage ( frey law et al ., 2008 : simmons ,chabal , griffith, rausch , & steele , 2004
) the positive impact of massage on pain reduction is often posited on the gate control theory ,with
massage stimulating the large – diameter never fibes that have an inhibitory input on T- cells ( furlan
et al.,2004 ) according to wang and keck , “massaging the hans and feet stimulates the
mechanorecptors that active the nonpainful nerve fibers, preventing pain transmission from
reaching consciousness” (p. 59 )

Results from some studies on the use of massage have show that massage does not always produce
relaxation .one factor contribute to these findings is that massage of short duration may initially
cause stimulation of the sympathetic nervous system and thus cause an increase in blood preassure
and heart rate . few studied have included information about subjects comfort with touch and
massage .for some persons , massage may increase anxiety.

The impact of massage on the psycohoneuroimmunological functions of the body and mind
is beginning to be explored. Billhult, linddholm, gunnarsson, and stener-victoria (2008) explored the
effect of massage on CD4 and CD8+ T cells in women with cancer. Findings revealed that massage
had no effect on these indices. Anecdotal reports, however, sugges that massage produces positive
results in persons with HIV infection.

Massage is a holistic therapy and, as such, promotes overall health. Improvement in well-
being has been shown in the following studies: emotional disconfort (currin and meister, 2008);
psychological weel-being (chang, wang, and chen, 2002); and quality of life (williams et al, 2005).

Intervention

As noted earliner, numerous types of massage exist. The techniquest for hand and shoulder massage
well be prsented.

The environment and which massage is administered is important. The room must be warm
enough for the person to be comfortable, as shivering could negate the effects of the massage. In
addition has been thought to increase the effectivenes of massage. Felloes, barnes, and willkinson
(2004), however, did not find any confincing evidence that aromatherapy contributed to additional
improvement in outcomes. Chapter 6 details intervention withh music ; aromatherapy is described
in chapter 26.

Massage stroke

Comonoly used strokes in administering massage inculde effluerage, friction, preasure, petrisage,
vibration, and percussion.

Efflurage

Efflurage is a slow, rhytmic stroking, with light skin contact. Effelurage my be applied with warying
degrees of preasur, depending on the part of the body being massaged and teh outcome desired.
The palmar surface of the hands is used for larger surfaces, the thumbs and fingers for smaller areas.
On large surfaces, long, gliding strokes about 10 to 20 inches in leghth are applied.
Friction movements

In friction movements, moderate, constant preassure to one area is made with the thumbs or
fingers. The fingers my be held in one place or moved in a small circumscribed area.

Pressure stroke

The pressure stroke is similar to the fricton stroke, except pressure strokes are made with the whole
hand.

Petrissage

Petrissage, or kneading, involeves lifting a large fold of skin and the underlying muscle and holding
the tissue between the thumb and fingers. The tissues are pushed against the bone, then raised and
aqueezed in circular movements. The grasp on the tissues is alternately loosened and tightened.
Tissues are supported be one hand while being kneaded with the other. Variations inculde piniching,
rolling, wringing, and kneading with fists or fingers. Petrissage is limited to tissues having a significan
muscle mass.

Vibration stokes

Vibration strokes can be administered with either the entire hand or with the finger. Rapid,
continous strokes are used. Because administering vibration strokes requres much energy,
mechanical vibrators are some time used.

Percussion strokes

For percussion strokes, the wrist acts as a fulcurm for the hand, with the hand hitting the tissue.
Strokes are made with a rapid tempo over a large body area. Tapping and clapping are variants of
percussion strokes.

Shoulder massage

Shoulder massage can be easly performed by nurses and other persons. The person receiving the
massage sits so that the back is accessible to the person administering the massage. The massage
can be administered with teh person’s shoulders uncovered or colthed. If colethed, no oil or lation is
used.

The massage begins with some gentle pressure applied on the shoulders using the palm og
the hand. Next, attention is given to strtching the trapezius muscles, moving from the center og the
back to the muscle’s insertion in the scapula at the shoulder joint. Fingers can be used to massage
the fibers in the muscles of the shoulder. Pertissage strokes are used to lift the skin and muscle
fibers so as to massage these tissues between the fingers. Atention is given to the attachement of
the muscules at the base of the skull by massanging up the neck and stretching the muscules. If a
person is unable to hold his or her head upright, a hand can be placed on the forehead to support
the head. The massage is concluded with lighter percussion strokes across the top of the shoulders
(M.O. Martin, march 2005, personal communication).
Hand massage