Massage TherapyMassage Therapy

History of MassageHistory of Massage Natural reaction to when the body hurts is to rub itNatural reaction to when the body hurts is to rub it Dates back to at least the ancient OlympicsDates back to at least the ancient Olympics In Europe in the Middle Ages, the Church of Rome & In Europe in the Middle Ages, the Church of Rome &

its religious teachings discouraged massage as a its religious teachings discouraged massage as a healing practicehealing practice

Massage is derived from 2 sourcesMassage is derived from 2 sources Arabic verb Arabic verb massmass “to touch” “to touch” Greek word Greek word masseinmassein “to knead” “to knead”

Egyptians, Romans, Japanese, Persians, & Chinese Egyptians, Romans, Japanese, Persians, & Chinese were known to practice massage therapywere known to practice massage therapy

History of MassageHistory of Massage Sweden – early 19Sweden – early 19thth century, Peter Ling century, Peter Ling (acknowledged (acknowledged

founder of curative gymnastics)founder of curative gymnastics) – appears to be founder of – appears to be founder of modern day massage techniques, incorporated with modern day massage techniques, incorporated with French massage techniquesFrench massage techniques

Techniques have changed dramatically in the past 50 Techniques have changed dramatically in the past 50 yearsyears Based on research by Albert Hoffa (1859-1907), James Based on research by Albert Hoffa (1859-1907), James

Mennell 1880-1957), & Gertrude Beard (1887-1971).Mennell 1880-1957), & Gertrude Beard (1887-1971). Scientific basis to massage was addedScientific basis to massage was added Late 1980’s, Amer. Massage Therapy Association was Late 1980’s, Amer. Massage Therapy Association was

organized (1992 – Nat’l Cert. Exam. For Therapeutic organized (1992 – Nat’l Cert. Exam. For Therapeutic Massage & Bodywork was formed)Massage & Bodywork was formed)

What is Massage Therapy?What is Massage Therapy? Mechanical modalityMechanical modality Used to manipulate the body’s tissueUsed to manipulate the body’s tissue Effective in promoting local & systemic relaxation, Effective in promoting local & systemic relaxation,

increasing local b. flow, breaking down adhesions, & increasing local b. flow, breaking down adhesions, & encouraging venous returnencouraging venous return

Act of rubbing, kneading, or stroking the superficial Act of rubbing, kneading, or stroking the superficial parts of the body with the hand or an instrument for parts of the body with the hand or an instrument for the purpose of modifying nutrition, restoring power the purpose of modifying nutrition, restoring power of movement or breaking up adhesionsof movement or breaking up adhesions

Time-consumingTime-consuming

Treatment Considerations & Treatment Considerations & GuidelinesGuidelines

Need to know underlying pathologyNeed to know underlying pathology Need to know basic massage principles (must have Need to know basic massage principles (must have

manual dexterity, coordination, & concentration). Must manual dexterity, coordination, & concentration). Must also exhibit patience & courteousness.also exhibit patience & courteousness.

Hands must be clean, warm, dry & soft. Nails must be Hands must be clean, warm, dry & soft. Nails must be short and smooth. Hands should be warm.short and smooth. Hands should be warm.

Avoid constant hyperextension or hyperflexion of any Avoid constant hyperextension or hyperflexion of any joints which may lead to hypermobility.joints which may lead to hypermobility.

Must obtain correct positioning that will allow for Must obtain correct positioning that will allow for relaxation, prevent fatigue & permit free movement of relaxation, prevent fatigue & permit free movement of arms, hands, & body.arms, hands, & body.

Treatment Considerations & Treatment Considerations & GuidelinesGuidelines

Must obtain good posture to prevent fatigue & Must obtain good posture to prevent fatigue & backache. backache.

Weight should be evenly distributed on both Weight should be evenly distributed on both feet.feet.

You must be able to fit your hands to the You must be able to fit your hands to the contour of the area being treated.contour of the area being treated.

A good position is required to allow for correct A good position is required to allow for correct application of pressure and rhythmic strokes application of pressure and rhythmic strokes during the procedure.during the procedure.

Points for ConsiderationPoints for Consideration Pressure regulation should be determined by Pressure regulation should be determined by

the type & amount of tissue present. Also, the type & amount of tissue present. Also, pressure is governed by the condition & which pressure is governed by the condition & which tissues are affected.tissues are affected.

Each stroke must have equal pressure & time Each stroke must have equal pressure & time (rhythm present).(rhythm present).

Duration depends on pathology, size of area, Duration depends on pathology, size of area, speed of motion, age, size, & condition of speed of motion, age, size, & condition of athlete. Also, massage may not be warranted athlete. Also, massage may not be warranted on a daily basis (e.g. friction massage).on a daily basis (e.g. friction massage). Some areas may take 30 minutes.Some areas may take 30 minutes.

Points for ConsiderationPoints for Consideration If swelling is present in an extremity, If swelling is present in an extremity,

treatment should begin proximally. treatment should begin proximally. ““Uncorking the bottle”, “uncorking effect”Uncorking the bottle”, “uncorking effect”

Massage should never be painful, except Massage should never be painful, except possibly for friction massage. It should not possibly for friction massage. It should not cause ecchymosis.cause ecchymosis.

Direction of forces should be applied in the Direction of forces should be applied in the direction of the muscle fibers.direction of the muscle fibers.

Each session should begin & end with Each session should begin & end with effleurage.effleurage.

Points for ConsiderationPoints for Consideration Make sure the patient is warm and in a comfortable, Make sure the patient is warm and in a comfortable,

relaxed position. Also, make sure the patient is relaxed position. Also, make sure the patient is properly draped.properly draped.

The body part may be elevated if necessary.The body part may be elevated if necessary. Massage should begin with superficial stroking.Massage should begin with superficial stroking. Each stroke should start at the joint or just below the Each stroke should start at the joint or just below the

joint (unless contraindicated) and finish above the joint (unless contraindicated) and finish above the joint so that strokes overlap.joint so that strokes overlap.

Pressure should be in line with venous flow.Pressure should be in line with venous flow. Bony prominences & painful joints should be avoided Bony prominences & painful joints should be avoided

if possible.if possible.

Massage MediaMassage Media Used to decrease friction between the Used to decrease friction between the

patient’s skin and the clinician’s handpatient’s skin and the clinician’s hand Massage can be given without any medium Massage can be given without any medium

being usedbeing used Lotions, peanut oil, powder, analgesic Lotions, peanut oil, powder, analgesic

balmsbalms More medium should be used on More medium should be used on

hairy areashairy areas During petrissage – lubricants During petrissage – lubricants

interfere with the kneading & liftinginterfere with the kneading & lifting During friction massage – During friction massage –

lubricants may interfere with lubricants may interfere with the certain results you want to the certain results you want to obtainobtain

Massage StrokesMassage Strokes

EffleurageEffleurage PetrissagePetrissage Friction (circular, transverse)Friction (circular, transverse) TapotementTapotement VibrationVibration Myofascial release techniquesMyofascial release techniques Various other forms – some may combine Various other forms – some may combine

strokesstrokes

Physiological Effects of Massage Physiological Effects of Massage TherapyTherapy

Depending on the amount of pressure applied & the Depending on the amount of pressure applied & the speed of the stroke, many results can occurspeed of the stroke, many results can occur Light, slow stroking – evokes systemic relaxationLight, slow stroking – evokes systemic relaxation Fast, deep strokes increase blood flow to the areaFast, deep strokes increase blood flow to the area

Cardiovascular changes – Cardiovascular changes – deep friction or vigorous deep friction or vigorous massage was thought to produce vascular changesmassage was thought to produce vascular changes Research failed to support those theoriesResearch failed to support those theories No increase in cardiac output, b.p., or increased arterial b. No increase in cardiac output, b.p., or increased arterial b.

flow were revealedflow were revealed Massage can produce decreased heart rate, breathing rate, Massage can produce decreased heart rate, breathing rate,

& b.p. if the purpose is for inducing system relaxation& b.p. if the purpose is for inducing system relaxation

Physiological EffectsPhysiological Effects PetrissagePetrissage has been shown to has been shown to decrease decrease

neuromuscular excitabilityneuromuscular excitability, but only during the , but only during the massage (effects confined to muscle being massage (effects confined to muscle being massaged)massaged)

Deep effleurageDeep effleurage, circular & transverse friction , circular & transverse friction has shown to has shown to improve flexibilityimprove flexibility

Massage is Massage is less effective in decreasing less effective in decreasing muscular recovery timemuscular recovery time, but may be effective , but may be effective (2 hrs post) in reducing amount of DOMS (2 hrs post) in reducing amount of DOMS Little reduction in m. fatigue when performing Little reduction in m. fatigue when performing

between exercise (pitcher, sprinter)between exercise (pitcher, sprinter)

Physiological EffectsPhysiological Effects Edema reduction – when performed properly it Edema reduction – when performed properly it

can can increase venous & lymphatic flowincrease venous & lymphatic flow Reduces painReduces pain

By decreasing pressure from swelling, mechanical By decreasing pressure from swelling, mechanical pain can be reducedpain can be reduced

By interrupting m. spasm, mechanical pain can be By interrupting m. spasm, mechanical pain can be reducedreduced

By reducing edema, mechanical pain can be reducedBy reducing edema, mechanical pain can be reduced By increasing b. flow & encouraging waste removal, By increasing b. flow & encouraging waste removal,

chemical pain can be reducedchemical pain can be reduced Activates sensory nerves – inhibits pain Activates sensory nerves – inhibits pain

Mechanical EffectsMechanical Effects Techniques that stretch a muscle, elongate Techniques that stretch a muscle, elongate

fascia, or mobilize soft-tissue adhesions or fascia, or mobilize soft-tissue adhesions or restrictions are all mechanical techniquesrestrictions are all mechanical techniques

Mechanical effects are always accompanied by Mechanical effects are always accompanied by some reflex effectssome reflex effects As mechanical stimulus becomes more effective, As mechanical stimulus becomes more effective,

reflex stimulus becomes less effectivereflex stimulus becomes less effective Muscle – massage is done either for Muscle – massage is done either for

mechanical stretching or to relieve pain mechanical stretching or to relieve pain associated with trigger pointsassociated with trigger points

Mechanical EffectsMechanical Effects

Skin – massage has been shown to increase Skin – massage has been shown to increase skin temperature, increase sweating & skin temperature, increase sweating & decrease resistance to electrical currentdecrease resistance to electrical current

It has been shown to toughen yet soften the It has been shown to toughen yet soften the skinskin

Acts directly on the surface of the skin to Acts directly on the surface of the skin to remove dead cellsremove dead cells

Stretches & breaks down fibrous tissueStretches & breaks down fibrous tissue

Psychological EffectsPsychological Effects

One-on-One treatmentOne-on-One treatment Reduces patient anxiety, depression, & mental Reduces patient anxiety, depression, & mental

stressstress Patient compliance is increasedPatient compliance is increased Patient gains confidence in clinicianPatient gains confidence in clinician

EffleurageEffleurage Stroking of the skinStroking of the skin Performed with palm of hand Performed with palm of hand

Stimulates deep tissuesStimulates deep tissues Performed with fingertipsPerformed with fingertips

Stimulates sensory nervesStimulates sensory nerves Superficial, rhythmic stroking: Superficial, rhythmic stroking:

Contours the body or relates to direction of Contours the body or relates to direction of underlying musclesunderlying muscles

Deep stroking:Deep stroking: Follows course of veins & lymph vesselsFollows course of veins & lymph vessels

EffleurageEffleurage May be performed slowly for relaxation or May be performed slowly for relaxation or

rapidly to encourage blood flow & stimulate rapidly to encourage blood flow & stimulate the tissuesthe tissues

Performed in rhythmic mannerPerformed in rhythmic manner One hand should always be in contact w/ skinOne hand should always be in contact w/ skin Light effleurage is performed at beginning & Light effleurage is performed at beginning &

end of massage or may be used between end of massage or may be used between petrissage strokespetrissage strokes At beginning – relaxes patient & indicates area to At beginning – relaxes patient & indicates area to

be treatedbe treated At end – calms down any irritated areasAt end – calms down any irritated areas

PetrissagePetrissage Lifting & kneading of skin, Lifting & kneading of skin,

subcutaneous tissue, & musclessubcutaneous tissue, & muscles Performed with fingers or handPerformed with fingers or hand Skin is gently lifted between Skin is gently lifted between

thumb & fingers or fingers & thumb & fingers or fingers & palm & gently rolled & kneaded palm & gently rolled & kneaded in the handin the hand

Often performed without lotionOften performed without lotion Frees adhesions by stretching & Frees adhesions by stretching &

separating muscle fiber, fascia, separating muscle fiber, fascia, & scar tissue while assisting & scar tissue while assisting with venous return & milking with venous return & milking out waste productsout waste products

FrictionFriction

Goal is to mobilize muscle & separate adhesions Goal is to mobilize muscle & separate adhesions that restrict movement & cause painthat restrict movement & cause pain

Facilitates local blood profusion Facilitates local blood profusion Not necessarily a “pleasing” treatmentNot necessarily a “pleasing” treatment Circular: Circular:

Applied with thumbs working in circular motionApplied with thumbs working in circular motion Effective in treating muscle spasm & trigger pts.Effective in treating muscle spasm & trigger pts.

FrictionFriction Transverse: Transverse:

Applied with thumbs or fingertips stroking the Applied with thumbs or fingertips stroking the tissue from opposite directionstissue from opposite directions

Can use elbow, end of rolling pin, etc. for larger Can use elbow, end of rolling pin, etc. for larger areasareas

Reaches deep tissuesReaches deep tissues Begin lightly and then move to firmer strokesBegin lightly and then move to firmer strokes Muscle should be placed in relaxed positionMuscle should be placed in relaxed position Should be avoided in acute conditionsShould be avoided in acute conditions Effective in tendonitis or other joint adhesionsEffective in tendonitis or other joint adhesions

TapotementTapotement Gentle tapping or pounding of the skinGentle tapping or pounding of the skin Most common form uses ulnar side of wrist to Most common form uses ulnar side of wrist to

contact skin “karate chop”contact skin “karate chop” Wrist & fingers are usually limp, alternate Wrist & fingers are usually limp, alternate

method “cups” the handmethod “cups” the hand Promotes relaxation & densitization of Promotes relaxation & densitization of

irritated nerve endingsirritated nerve endings

VibrationVibration

Rapid shaking of the tissuesRapid shaking of the tissues Soothes peripheral nervesSoothes peripheral nerves A mechanical device can be usedA mechanical device can be used

Myofascial Myofascial ReleaseRelease

Involves effleurage, petrissage & friction massage Involves effleurage, petrissage & friction massage strokes with stretching of muscles & fasciastrokes with stretching of muscles & fascia

Tries to obtain relaxation of tense and/or adhered Tries to obtain relaxation of tense and/or adhered tissues (myo – muscle; fascia – band; ease the tension tissues (myo – muscle; fascia – band; ease the tension of fibrous CT bands)of fibrous CT bands)

No structured patternNo structured pattern Involves pulling of tissues in opposite directions, Involves pulling of tissues in opposite directions,

stabilizing the proximal/superior position w/ one stabilizing the proximal/superior position w/ one hand while applying a stretch w/ opposite hand, or hand while applying a stretch w/ opposite hand, or using the patient’s body weight to stabilize the using the patient’s body weight to stabilize the extremity while a longitudinal stress is appliedextremity while a longitudinal stress is applied

Can involve more than one clinicianCan involve more than one clinician

Myofascial ReleaseMyofascial Release Purpose is to relieve soft tissue from abnormal Purpose is to relieve soft tissue from abnormal

grip of tight fasciagrip of tight fascia May also be known as soft-tissue mobilizationMay also be known as soft-tissue mobilization Treatment is based on localizing the restriction Treatment is based on localizing the restriction

& moving into the direction of the restriction& moving into the direction of the restriction Very subjective & relies on experience of Very subjective & relies on experience of

clinicianclinician Recommended to treat at least 3 x per weekRecommended to treat at least 3 x per week

AcupressureAcupressure Acupressure – based on Chinese art of AcupunctureAcupressure – based on Chinese art of Acupuncture The Chinese make no distinction between arteries, The Chinese make no distinction between arteries,

veins, or nerves when explaining function of the body. veins, or nerves when explaining function of the body. Concentrate on the system of forces that regulate all bodily Concentrate on the system of forces that regulate all bodily

functions.functions. Qi (pronounced “che” exists in everyone & controls all Qi (pronounced “che” exists in everyone & controls all

aspects of life)aspects of life) Qi is governed by two opposing forces, Yang (positive) & Qi is governed by two opposing forces, Yang (positive) &

Yin (negative) forces. Disease results from some imbalance Yin (negative) forces. Disease results from some imbalance between these two forces.between these two forces.

Yin & Yang pass flow through passageways/lines in the body Yin & Yang pass flow through passageways/lines in the body called “jing” (Chinese) or “meridians” (West).called “jing” (Chinese) or “meridians” (West).

AcupressureAcupressure 12 meridians in the body 12 meridians in the body

named according to the part named according to the part of the body with which they of the body with which they are associated. The are associated. The meridians on one side of the meridians on one side of the body are duplicated on the body are duplicated on the other side; however, two other side; however, two additional meridians exist additional meridians exist that can’t be paired.that can’t be paired.

*not paired*not paired

Lung (L)Lung (L) Large Intestine (LI)Large Intestine (LI) Stomach (ST)Stomach (ST) Spleen (SP)Spleen (SP) Heart (H)Heart (H) Small Intestine (SI)Small Intestine (SI) Urinary bladder (UB)Urinary bladder (UB) Kidney (K)Kidney (K) Pericardium (P)Pericardium (P) Triple warmet (TW)Triple warmet (TW) Gall bladder (GB)Gall bladder (GB) Liver (LIV)Liver (LIV) Governing vessel (VB)*Governing vessel (VB)* Conception vessel (CV)*Conception vessel (CV)*

AcupressureAcupressure Along the meridians lie the acupuncture pointsAlong the meridians lie the acupuncture points

Whenever there is pain or illness, certain points on Whenever there is pain or illness, certain points on the surface of the body become tenderthe surface of the body become tender

When pain is eliminated, these tender spots When pain is eliminated, these tender spots disappeardisappear

According to acupuncture theory, stimulation According to acupuncture theory, stimulation of specific points through needling can reduce of specific points through needling can reduce pain in areas associated with a particular pointpain in areas associated with a particular point

Thousands of points have been identifiedThousands of points have been identified

AcupressureAcupressure

Electrical resistance of the skin at certain Electrical resistance of the skin at certain points corresponding to the acupuncture points points corresponding to the acupuncture points is lower than that of surrounding skin, is lower than that of surrounding skin, especially when a disease state is present.especially when a disease state is present.

Russian research has shown evidence of skin Russian research has shown evidence of skin temperature difference at these points.temperature difference at these points.

Myofascial Trigger PointsMyofascial Trigger Points

Trigger points are the counterpart of Trigger points are the counterpart of acupuncture pointsacupuncture points

May be found in muscle, tendons, myofascia, May be found in muscle, tendons, myofascia, ligaments & capsules surrounding joints, in ligaments & capsules surrounding joints, in periosteum, & in the skinperiosteum, & in the skin

May activate & become painful due to traumaMay activate & become painful due to trauma Stimulation of these points have resulted in Stimulation of these points have resulted in

pain reliefpain relief

What to do…. What to do…. Location of points: Use an ohmmeter to differentiate the Location of points: Use an ohmmeter to differentiate the

electrical impedance of areas OR electrical impedance of areas OR palpate the area until palpate the area until either a small fibrous nodule or strip of tense muscle either a small fibrous nodule or strip of tense muscle tissue that is tender to the touch is felt.tissue that is tender to the touch is felt.

Once located, massage is begun using the thumb, index Once located, massage is begun using the thumb, index or middle fingers or the elbow. or middle fingers or the elbow.

Perform small friction-like circular motions over the Perform small friction-like circular motions over the point.point.

Amount of pressure should be determined by patient Amount of pressure should be determined by patient tolerance, and may be intense and painful.tolerance, and may be intense and painful.

Treatment time – 1-5 minutes at a single point.Treatment time – 1-5 minutes at a single point. Patient will report a dulling/numbing effect & will Patient will report a dulling/numbing effect & will

report the pain diminishes.report the pain diminishes.

RolfingRolfing

May also see it is “structural integration”May also see it is “structural integration” GoalGoal - to balance the body within a - to balance the body within a

gravitational field through a technique gravitational field through a technique involving manual soft-tissue manipulationinvolving manual soft-tissue manipulation Improve balance, posture, flexibility, movement Improve balance, posture, flexibility, movement

efficiency efficiency Basic principle of treatment is - if balanced Basic principle of treatment is - if balanced

movement is essential at a particular joint, yet movement is essential at a particular joint, yet nearby tissue is restrained, both the tissue & the nearby tissue is restrained, both the tissue & the joint will relocate to a position that accomplishes a joint will relocate to a position that accomplishes a more appropriate equilibrium.more appropriate equilibrium.

RolfingRolfing Standardized approach that is administered without Standardized approach that is administered without

regard to symptoms or pathologiesregard to symptoms or pathologies Technique involves 10 hour-long sessions, each Technique involves 10 hour-long sessions, each

emphasizing some aspect of postureemphasizing some aspect of posture 10 sessions include:10 sessions include:

Respiration, balance under the body (legs/feet), sagittal Respiration, balance under the body (legs/feet), sagittal plane balance (lateral line from front to back), balance left plane balance (lateral line from front to back), balance left to right (base of body to midline), pelvic balance (rectus to right (base of body to midline), pelvic balance (rectus abdominis & psoas), weight transfer from head to feet – abdominis & psoas), weight transfer from head to feet – sacrum, relationship of head to rest of body, upper ½ of sacrum, relationship of head to rest of body, upper ½ of body to lower ½ of body relationship, balance throughout body to lower ½ of body relationship, balance throughout the systemthe system

Additional “tune-up” sessions may be requiredAdditional “tune-up” sessions may be required Integrates structural with psychological approachIntegrates structural with psychological approach

ReferencesReferences

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