THERAPEUTIC

MASSAGE
MUTHUUKARUPPAN M.
Introduction to Massage
o Massage is a systematic manual
application of pressure and
movement to the soft tissue of the body-
the skin, muscles, tendons, ligaments,
and fascia.
o In North America, massage is considered
to be alternative medicine, Elsewhere it
has been regarded as an component of
mainstream health care.
History of Massage
o Natural reaction, when the body hurts is to
rub it.
o Dates back to the ancient Olympics.
o Massage is derived from 2 sources
o Arabic verb mass to touch
o Greek word massein to knead
o Egyptians, Romans, Japanese, Persians, &
Chinese were known to practice massage
therapy
Physiological Effects of Massage
o Depending on the amount of pressure applied
& the speed of the stroke, many results can
occur
o Light, slow stroking Evokes systemic relaxation
o Fast, deep stroking Increase blood flow to the area
o Cardiovascular changes :
o Deep friction or vigorous massage was thought to
produce vascular changes. Research failed to
support those theories
o Massage can produce decreased heart rate,
breathing rate, & b.p. if the purpose is for inducing
system relaxation
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)
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 muscle spasm, mechanical pain can be
reduced.
By reducing edema, mechanical pain can be reduced.
By increasing blood flow & encouraging waste removal
& chemicals.
Activates sensory nerves inhibits pain
Mechanical Effects
o Techniques that stretch a muscle, elongate
fascia, or mobilize soft-tissue adhesions or
restrictions are all mechanical techniques
o Skin massage has been shown to increase
skin temperature, increase sweating &
decrease resistance to electrical current
o It has been shown to toughen yet soften the
skin
o Acts directly on the surface of the skin to
remove dead cells
o Stretches & breaks down fibrous tissue
Psychological Effects
o One-on-One treatment
o Reduces patient anxiety, depression, &
mental stress
o Patient compliance is increased
o Patient gains confidence in clinician
Indications:
1. Increase venous return
2. Break painspasmpain cycle
3. Evoke systemic relaxation
4. Improve or stimulate local blood flow
Contraindications:
1. Acute sprains and strains: massage may
a. Increase the inflammatory response
b. Cause myositis ossificans
2. Over skin with lesions or disease conditions
a. May spread disease over the patient or to
therapist
3. Sites where fractures have failed to heal
4. People hypersensitive to touch
Precautions:
1. Pitting edema
2. Hypertension
Massage Strokes
Effleurage
Petrissage
Friction (circular, transverse)
Percussion or Tapotement
Vibration
Myofascial release techniques
Various other forms some may combine
strokes
Effleurage:
Gliding manipulation performed with light
centripetal pressure that deforms
subcutaneous tissue down to the deep fascia
Directed toward the heart or proximally
Effleurage:
o Keys to applying
effleurage
o Apply rhythmic stroking on
the skin.
o Can be either light or deep
o Light massage promotes
relaxation and sensory
reflexes.
o Deep massage promotes
mechanical effects.
o Increases blood and
lymphatic circulation.
Effleurage
o Deep stroking
o Follow the course of veins and lymph vessels.
o Superficial stroking
o Follow the contour of body or the underlying
tissue.
o Use palms of both hands in a deliberate,
rhythmic fashion.

Effleurage
o Keep one hand in contact with skin at all
times by stroking in one direction with both
hands and return to beginning with light
finger tip contact or stagger hands, making
contact with the second before lifting the first
from the body.
o Begin and end massage with light effleurage.

Ptrissage
o From the French
ptrir, to knead
o Group of related
techniques that
repetitively compress,
(squeeze) shear,
(wring), and release
muscle tissue with
varying amounts of
drag
o Lift and glide

Ptrissage
o Keys to applying ptrissage:
o Lift and knead the tissue (skin,
subcutaneous, muscle).
o Lift tissue between thumb and fingers or
fingers and palm.
o Then gently roll and knead tissue in hand.
Ptrissage
o Gently wring muscle
between two hands as
if you were wringing
water out of a dishrag.
o Often performed
without lubricant or
lotion
o Stretches and
separates muscle fiber,
fascia, and scar tissue
Friction
o Repetitive, specific,
nongliding,
shearing technique
that produces
movement between
the fibers of dense
connective tissue
o Increasing tissue
extensibility
o Promotes ordered
alignment of
collagen within the
tissues
Friction
o Rationale for applying friction massage is to
mobilize muscle and separate adhesions in
muscle, tendons, or scar tissue that restrict
movement and cause pain.
o Sometimes chronic inflammation occurs
because an injury does not go through the
normal stages of inflammation and healing.
o The purpose is to try and increase inflammation
(jump-start it) to a point at which the
inflammatory process will run its normal
course.


Friction
o Keys to applying friction massage
o Can be applied in a circular or transverse fashion
o If circular, thumbs work in circular motion.
o If transverse, thumbs stroke tissue from
opposite directions.
o Should be applied across fibers when treating a
ligament or tendon
o When treating scar tissue in which the
collagen has less regular organization,
directions may be alternated or applied in a
circular motion.

Friction
o Can use elbow on large muscles
o Place muscle in relaxed position.
o Apply sufficient pressure to reach deep into
tissue
o Do not use on acute injury
o Usually is painful
o May be followed by stretching to increase ROM
Percussion
o Tapotement
o Repeated rhythmical light striking of the skin
o Techniques:
o Gentle tapping
o Pounding
o Cupping
o Hacking
o Two main uses
o For respiratory ailments to promote phlegm
mobilization
o Stimulation for precompetition preparation

Percussion
o Keys to applying
percussion
massage
o Hacking is done
with the ulnar side
of hand, with wrist
and fingers limp
o Karate chop
o During cupping,
only the rim of the
hand should come
in contact with the
body

Vibration
o Shaking
o Repetitively moving soft
tissue back and forth
over the underlying bone
with minimal joint motion
o Principal uses
o Relaxation of skeletal
muscle
o As a stimulus for
precompetition and
intercompetition owing to
its effects of systemic
arousal and enhanced
awareness
Vibration
o Keys to applying
vibration massage
o Apply moderate to
rapid shaking
strokes to the skin.
o Rapid for pre
competition
o Moderate for post
competition
o Can be applied with
the hands or with a
machine
Myofascial Release
o Combination of
traction with varying
amounts of stretch
o Used to produce a
moderate sustained
force on the muscle
and its fascia
o Currently, Active
Release Technique is
popular among
Chiropractors
Myofascial Release
o Goal is to produce viscoelastic lengthening
(creep) and plastic deformation of the fasacia.
o Indicated to
o Lengthen fascial layers
o Restore mobility between fascial layers
o Decrease the effects of adhesions
o Indicated for conditions in which chronic
fascial shortening results in limited joint ROM
and ease of movement .


Setup for Therapeutic Massage
o Check for indications and contraindications
o Ensure a suitable environment, including
o Comfortable room temperature (6872F)
o Upholstered table to protect pressure points
and bony prominences (pelvic bones,
ankles, head)
o Relaxed atmosphere
o Position of patient
o Both patient and clinician should be comfortable;
minimize overuse with good ergonomic positioning
o Place rolled up towel under body parts (for
instance the ankle) to increase comfort.

Setup:
o Make sure patient is properly draped with
towels to ease apprehension about nudity (If
massage involves body parts where this may
be a concern).
o Determine the type of massage to give.
o What strokes to use and in what order
o Determine use of lubricants.
Massage Lubricants
o Used to decrease friction and control the
amount of glide and drag that occurs between
the clinicians moving hands and the clients
skin
o Aids some techniques (where gliding is required)
o Hinders some techniques (friction)
o Should be hypoallergenic
o To Avoid risk of contamination, dispense from:
o Squeeze bottle, Pump, Shaker
o Four main types
o Lotions, Oils, Creams, Powders

Parameters for Massage
o There are no set procedures.
o Clinician designs application to meet individuals
needs.
o Some Physical Therapists believe in no more than
6-8 min. per area of treatment, or other modalities
should be used instead.
o During the treatment, seek feedback concerning
patients response to treatment by periodically
asking questions, such as
o How are you feeling?
o Is it tender here?
o Is this pressure OK?
Massage Post application &
Maintenance

o Clean up massage lubricant.
o Make appointment for next treatment.
o Instruct patient concerning activity level
and self-treatment before next formal
treatment.
o Record treatment and any special
responses to the treatment.
o Keep hands free of calluses.
Treatment Considerations &
Guidelines
o Need to know basic massage principles (must
have manual dexterity, coordination, &
concentration). Must also exhibit patience &
courteousness.
o Hands must be clean, warm, dry & soft. Nails
must be short and smooth. Hands should be
warm.
o Avoid constant hyperextension or hyperflexion of
any joints which may lead to hypermobility.
o Must obtain correct positioning that will allow for
relaxation, prevent fatigue & permit free
movement of arms, hands, & body.
Treatment Considerations &
Guidelines
o Must obtain good posture to prevent fatigue &
backache.
o Weight should be evenly distributed on both
feet.
o You must be able to fit your hands to the
contour of the area being treated.
o A good position is required to allow for correct
application of pressure and rhythmic strokes
during the procedure.
Points for Consideration
o Pressure regulation should be determined by
the type & amount of tissue present. Also,
pressure is governed by the condition & which
tissues are affected.
o Each stroke must have equal pressure & time
(rhythm present).
o 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).
o Some areas may take 30 minutes.
Points for Consideration
o If swelling is present in an extremity,
treatment should begin proximally.
o Massage should never be painful, except
possibly for friction massage. It should not
cause ecchymosis.
o Direction of forces should be applied in the
direction of the muscle fibers.
o Each session should begin & end with
effleurage.
Points for Consideration
o The body part may be elevated if necessary.
o Massage should begin with superficial
stroking.
o Each stroke should start at the joint or just
below the joint (unless contraindicated) and
finish above the joint so that strokes overlap.
o Pressure should be in line with venous &
Lymphatic flow.
o Bony prominences & painful joints should be
avoided if possible.
ANY
QUESTIONS
???