Understanding Therapeutic Massage Techniques

Therapeutic Massage. Massage is a systematic manipulation of the body's tissues. Massage has a documented historical presence in nearly all cultures and can be traced back as far as the ancient Olympics. Massage is one of the oldest forms of a healing technique. Using therapeutic touch, the body's tissues are manipulated to reduce muscle spasm. promote relaxation, improve blood flow, and increase venous drainage. Even though massage is one of the oldest techniques that therapists utilize, it is still used in modern medicine very frequently. There are many techniques and strokes that can be utilized in massage therapy. We will explore the strokes and the techniques that are most frequently used for therapeutic rehabilitation purposes. The term massage, massage therapy, and manual therapy are often used interchangeably and are often discussed in relation to bodywork and somatic therapy. There are more than 250 variations of massage, bodywork, and somatic therapies. The massage community is inclusive of three groups of therapies. Massage, the application of soft tissue manipulation techniques to the body generally intended to reduce stress and fatigue. while improving circulation, body work, various forms of touch therapies that may use manipulation, movement, and or and or repatterning to affect structural changes to the body. Somatic meaning of the body. Many times this term is used to denote a body-mind or whole-body approach as distinguished from a physiology-only or environmental perspective. Unfortunately, due to perception, sometimes performing a massage does not always look right to someone who passes by or walks past a room. Therefore, it is vitally important to always keep the perception of your treatment as professional as possible. Good communication with your patient and with others is extremely important. Gaining consent and explaining the treatment is key to protecting yourself. Additionally, think about the setting in which you are providing treatment to your patients, and even the age or gender of your patients is something to consider. Therapists and clinicians are often required to massage different parts of the body, either on a same gender or opposite gender person. Remember, as an athletic trainer or other healthcare professional, you are not a massage therapist. A massage therapist's sole job is to perform massages for financial gain, but the type of setting in which these massages are performed, for example, private rooms for each patient, is not always available in the therapeutic setting. Therefore, it is essential that every clinician adhere to the highest ethical standard possible when performing massage in the therapeutic setting. There is a high potential for actions during massage to be misconstrued by either the patient you are working on or by others around the patient. Remember, perception is whatever other people think, believe, understand, or interpret a situation as. One person's perception may be different than another's and may even differ from reality, but unfortunately, people's perception is their truth. and what they believe is going on in a situation. You, as the clinician, need to make sure that you are protecting yourself first and the situation from being incorrectly perceived or perceived differently than what you intend. People's culture, religion, background, experiences, and expectations all play into their perception. So, it is important to be aware of your surroundings and every situation is treated differently. For example, what if there was a male patient and a female therapist? Or even vice versa, a female patient and a male therapist. Now, let's place this scenario in a private room. Does that change your perception? Maybe or maybe not. Some people would be fine with this. Others would think that there is something wrong with this picture. or may even perceive it as inappropriate. Even though the intent of the massage is a professional one, I would highly encourage you to think about the perception that massaging someone in a private room instead of a therapeutic room is sending to others. It is my recommendation that it is better to be safe than sorry. If you're going to perform a massage in a private room, you might want to consider having another adult present during the treatment session. In order to work with the highest standards of professionalism, I would encourage you to consider these issues when performing a therapeutic massage. Other suggestions to maintain the highest standard of professionalism include avoiding unnecessary touching and or overexposing the patient. Consider your own personal hygiene and cleanliness. During a massage, you are in very close contact with other people. So if body odor is an issue or there is even gunk underneath your fingernails, your patient may not feel comfortable with the treatment. The same thing with wearing heavy perfume. And patient comfort is very important during this type of treatment. Oftentimes, we need our patient to relax. Drape, drape, and drape. Please make sure to cover your patient appropriately. You should only need to expose the area that you need to work on, but I would highly encourage you to have extra towels, sheets, or even blankets in which to drape over other areas not being treated. Draping helps to keep your patient warmer, which increases their level of comfort, and also protects their privacy. Use a spotter if needed. This person can help you place the patient in the correct position, or may just be there as a witness to the therapeutic treatment. There is nothing harder to defend an illegal court than a he said, she said, or he said, he said, or she said, she said type of argument. Go into the massage with confidence. The more confident that you are, the more your patient can relax and get the full benefit out of the treatment. Get verbal consent prior to beginning the massage. Please realize that in some cultures, religions, and even just some personal preferences are against personal touching. If your patient says no, then massage is not the right treatment for them, and we will have to come up with another alternative. Please remember to remove watches, rings, and to trim your long or jagged fingernails. Since you are utilizing your hands most frequently to perform massages, Anything that could scratch or be uncomfortable to the patient should be removed prior to starting the massage. Another major issue would be to avoid any awkwardness while you are performing the massage. Sometimes bodily functions such as passing gas, having the massage lotion or oil make an awkward noise, having body parts shift across the table or stick to the table, or slipping off of a knot while you are performing a massage may occur. As a clinician, it is best just to let it go, not say anything, and move on. Eventually, it happens to all of us, and it isn't a secret that we all perform these bodily functions. It really isn't a big deal, and it is not a good idea to laugh or make comments to your patient, who may or may not be embarrassed by the situation. If a patient says something or feels too embarrassed to continue, then you should stop the treatment immediately. Also, be careful about what you talk about during the massage. It is better to have some idle chatter, such as talking about the weather, sports, or even the news, rather than talk about personal issues. Also, be very careful of making comments about people's anatomy or even the way they look. Many people are self-conscious. and any comments could make the situation awkward or may lead to perceptions of unprofessionalism. Some individuals do not care, while others are highly sensitive to various situations. In order to perform a quality massage, it is imperative that you have a solid knowledge of anatomy. You need to understand when you are rubbing an area or a patient has soreness, what tissues may be affected. Is the pain or soreness coming from muscle, tendon, fascia, or something else? What layer of muscle are you dealing with? It is also important to study touch and feel of your patients. Usually this comes from hours and hours of practice. The more people you can perform massages on, the easier it is to become comfortable and knowledgeable in the way things are supposed to feel and what is considered unusual. or a different presentation. I would highly encourage you all to pay attention to anatomy. While I understand learning the muscle origin, insertion, action, innervation, and palpations can seem tedious, this knowledge is very important to clinicians, both within therapeutic interventions and within rehabilitation. There are many different types of massage. The 10 most common massage techniques for athletes include Swedish massage. This is the traditional, classic, and basic massage technique and is most often what people think of for massage therapy. This technique is used for both relaxation and injury rehabilitation. Swedish massage includes different strokes including effleurage, petrissage, friction, tapotement, and vibration. all of which will be covered. Sports massage. This is the application of Swedish massage techniques to athletes and others involved in physical activity. The focus is on preventing and treating injuries to enhance athletic performance. Research has provided mixed support for the use of massage to aid in muscle recovery or performance after intense exercise among case series and randomized controlled trials. Myofascial release, also known as MFR. This is light sustained pressure that is applied in the opposite direction, allowing for tissues to be gently stretched and release of myofascial restrictions that inhibit movement or cause pain. Graston. This is an instrument-assisted soft tissue mobilization method that requires specific training and certification. The stainless steel instruments are designed with a unique curvilinear treatment edge, contoured to fit various shapes of the body, rolfing or structural integration, this is vigorous deep tissue massage, and myofascial release to restore normal body alignment, structure, and function. A key principle is that fascial contractures result from chronic dysfunction movements and imbalance muscular tension, resulting in pain and lessened muscle and joint motion. The body must be released from these learned patterns and mal-aligned structures. Neuromuscular therapy or NMT. Practitioners address comprised or entrapped nerves by osseous or myofascial structures, trigger points, postural distortion or imbalance, emotional factors, and ischemia and nutritional deficiencies. A variety of techniques are used, including trigger point pressure release, cryospray, needling, and myofascial release. Proponents suggest that it improves functioning of the immune system, glands, joints, muscles, and related soft tissues. Shiatsu. This is a form of Japanese pressure point therapy, similar to trigger point therapy, but concentrates on the application of pressure to acupuncture points. One specific type of shiatsu massage is known as prenatal or postpartum massage. Specific strokes and positions are used with women to address muscular issues that occur secondary to pregnancy. Craniosacral therapy or CST. This is a gentle, hands-on method of enhancing the craniosacral system, the spine and the membranes, and the cerebrospinal fluid that surrounds and protects the brain and spinal cord. The goal. is to improve the central nervous system by releasing restrictions of the cranial sacral system. Trigger point therapy. This therapy includes repetitive cycles of isolated pressure and release over a trigger point. A trigger point is a painfully tight area in a muscle caused by muscle overuse or injury. Reflexology. This treatment involves the application of fingers and thumb pressure. to specific reflex areas of patients'hands and feet that are thought to correspond to all of the glands, organs, and parts of the body. Advocates claim this treatment helps to promote the unblocking of nerve impulses and helps nature achieve homeostasis. Depending upon the stroke of the massage, it may require the use of lubricants to increase the comfort for the patient. There are many different types of lubricants including powders, creams, and oils. The amount of lubricant needed depends upon the technique and the strokes that will be utilized during the treatment. One of the most important things to consider when performing the massage is both the patient and the clinician comfort. You will have to decide whether you want your patients to lay supine, prone, or prone to side-lying, or even sitting upright for the massage. Making sure that your patient can breathe, can relax, and is comfortable during the entire massage is very important to the treatment. These are many examples of different tools that can prop, support, or allow your patient to be massaged in comfort. The prone pillow allows the patient to lie prone with the head straight. There are ventilation channels that allow for fresh air to get to the patient's face during the massage. In some instances, a prone table can be used that has a prone pillow as an attachment. You may also want a patient to be seated and therefore there are massage chairs available. In addition, the use of movable wedges and bolsters can help make your patient comfortable. during the massage. Certain conditions may require that a patient not lay flat on their back such as pregnancy and severe obesity among other conditions. Therefore, having your patient in a side-lying position may be an option as well. In addition to patient comfort, as a clinician, you may be performing the massage for a while. Therefore, it is vital that you use good posture as well. Whenever possible, use large muscle groups which will allow you to use your body weight to perform massages or can allow you to support yourself well during a massage. I would encourage the use of an adjustable height table as well when possible. Invest in a stool that can allow you to adjust your height to the table so that you can work at the best angle possible. I would encourage you not to lean over the table as your low back will not appreciate it. and typically the massage will be cut short as your body cannot stay in this position long before starting to hurt. Pick the right table height so that you can use your body to work efficiently. If you cannot readjust the table, then readjust yourself. Get a stool or maybe even kneel on the table. You need to make sure that you as the clinician are not injuring yourself while you're trying to treat others. Massage can be very tiring to the hands, depending upon the strokes. You can utilize different parts of the hands so you don't get so tired. The most common parts of the hand utilized for massage therapy are the entire palmar surface, hypothenar eminence, thenar eminence, the heel of the hand, the fingertips, finger pads, knuckle, fist, elbow, and the list goes on. You can be creative. If you are going to use massage tools, make sure that they are the right ones. They should not be wooden kitchen spoons. For a little laugh, check on Blackboard. There is a clip from an old Friends episode in which the wrong tools are being utilized for massage. While this clip has hilarious results, it is important that we are using the right tools and being professional at all times. Also, please make sure that your pressure and your touch is a friendly one. Just because you personally like more pressure does not necessarily mean that all of your patients do. Be sure to communicate with your patient to make sure that they are comfortable during the treatment. Looking at a patient's face during the treatment can also help you determine if the pressure is good. Some of you have very bony fingers, so just be aware of that while you're performing the massage. Massage techniques are utilized for many different purposes. Some of the most common uses for massage include painful conditions of musculoskeletal origins, muscle strains, muscle spasms, myofascial adhesions, and trigger points. Fascia is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches, stabilizes, encloses, and separates muscle and other internal organs. Fascia is classified by layer. as superficial fascia, deep fascia, and visceral or parietal fascia, or by its function and anatomical location. Fascia are similar to ligaments and tendons as they have collagen as their major component. They differ in their location and function. Ligaments join bone to another bone, tendons join muscle to bone, and fascia surrounds muscles and other structures. Fascia is made up of fibrous connective tissue containing closely packed bundles of collagen fibers oriented in a wavy pattern parallel to the direction of pull. Fascia is consequently flexible and able to resist great unidirectional tensional force until the wavy pattern of the fiber has been straightened out by the pulling force. These collagen fibers are produced by fibroblasts located within the fascia. Fascia is located pretty much everywhere in the body and has a spider web-like appearance. The physiological effects associated with massage include vasodilation or an increased blood flow. During massage, histamine is released which causes an increase in the body and tissue temperature. There is an increased venous and lymphatic return, and also a sedation or decreased activity of the nerve endings, which could reduce pain perception. There is also an associated elongation of muscle, fascia, and the capsule, which may help to decrease the effects of delayed onset muscle soreness, or DOMS. Depending upon the type of massage, relaxation, decreased heart rate, decreased respiratory rate, and a decrease in blood pressure are also seen. For many people, massage creates a general feeling of well-being. Never underestimate the power of a healing touch. Humans are not the only ones who participate in massage to feel good. Cats will massage each other too. See cat massages, they really do exist. Massage affects tissue through four primary effects, biomechanical, physiological, neurological, and psychological. The biomechanical effect of massage comes from the mechanical pressure on the tissues. This results in decreased tissue adhesion, increased muscle compliance, increased joint range of motion, decreased passive stiffness, and decreased active stiffness of the muscles. The physiological effect of massage comes from the changes in the tissue or the organ. This results in an increase in muscle blood flow, increased skin blood circulation, increased parasympathetic activity. Increased relaxation hormones and decreased stress hormones being released. The neurological effect of massage comes from the reflex stimulation. This results in a decrease in the neuromuscular excitability, decreased pain, and decreased muscle tension or spasm. The psychological effect of massage comes from the increased relationship between body and mind. This results in an increase in relaxation. and a decrease in overall anxiety. The indications, precautions, and contraindications of massage. The primary indication for the use of massage includes edema reduction, muscle spasm, scar tissue, myofascial adhesions, decreased range of motion, and increased muscle tone. The precautions for the use of massage include impaired sensation. To remedy this, we can apply decreased pressure. but we still need to be careful. We also need to be aware of patients who have hypertension. Depending upon the stroke that we are using in massage, blood pressure could potentially rise. The contraindications for the use of massage include acute injuries and areas of active inflammation. We do not want to increase any inflammation in the area. Open skin lesions or dermatological diseases, vascular disease such as blood clots, infections, unhealed fractures, and people who are hypersensitive to touch. There are multiple strokes that are associated with massage. For the sake of this lecture, we will focus on the most common ones, which include effleurage, petrissage, friction, tapotement, and vibration. Myofascial release is a different type of massage, but is commonly used in the sports setting, just like Swedish massage or sports massage. Effleurage is a stroking of the skin. We typically use effleurage to warm the patient up to our touch and to gauge areas of tightness within the patient. All effleurage strokes are performed in a rhythmic manner. Strokes should be directed towards the heart. The thumbs can be used to fit into anatomical contours such as between the toes or behind the malleoli. Lastly, at least one hand should be in contact with the patient at all times. Superficial stroking stimulates the tissues and encourages blood flow if done fast. Slow superficial stroking promotes relaxation of the patient. Deeper stroking stimulates deeper tissues and forces fluids in the direction of the stroke. We typically use effleurage at the beginning and the end of massage treatments. It can also be used between petrissage strokes to make the patient more comfortable. At the beginning of the massage, we are introducing our hands to the patient. This stroke helps to relax the patient and to scan the area for tightness. At the end of the massage, we use effleurage to calm down irritated nerves. Here are some examples of effleurage. Please also watch the associated YouTube videos on Blackboard for more insight on the stroke. Petrissage is similar to kneading dough. Petrissage is the lifting, kneading, and rolling of the skin, subcutaneous tissue, and the muscle with the fingers or the hands. This stroke is similar to myofascial skin rolling. Petrissage targets the underlying muscle and is particularly useful in superficial, mobile muscles such as the upper trapezius or the forearm muscles. Petrissage frees adhesions by stretching and separating muscle fibers, fascia, and scar tissue. This technique milks metabolic waste products, assists in venous return, and can lead to muscular relaxation. Here are some examples of petrissage. Please also watch the YouTube videos on Blackboard for more insight on this stroke. The tapotement stroke is a gentle tapping, wrapping, or pounding on the skin. Tapotement promotes muscular and systemic relaxation. It also desensitizes irritated nerve endings. Tapotement is often used following vigorous techniques such as friction or petrissage. Tipotment may also be used when you are trying to get the patient to relax and may be performed over clothing. Different forms of tipotment include cupping in which the hands are cupped when striking the skin, hacking in which the lateral side of the hands are used to strike the skin, and even pinching where the skin is sort of gently pinched. Another technique is slapping in which the skin is gently slapped to form a percussion. Here are some examples of tapotement. Please also watch the YouTube videos on Blackboard for more insight on the stroke. Friction massage mobilizes muscle fibers and separates adhesions on muscles, tendon fibers, or scar tissue that restrict motion and cause pain, and it is used to facilitate local blood perfusion. There are two primary types of friction massage, circular and transverse. also known as cross friction or cross fiber massage. Circular friction massage occurs with the two thumbs moving over a small area in a circular motion. Circular friction massage is great for treating muscle spasms, trigger points, and scar tissue. The transverse or cross fiber massage occurs when the thumbs or fingertips are moved in the opposite direction. The treatment is typically performed by the patient. perpendicular to the tissue being treated. Transverse massage is great for treating muscle spasms, trigger points, and motor points. This massage stroke is most often used for tendinitis. Here are some examples of friction massage. Please also watch the YouTube videos on Blackboard for more insight on the stroke. Vibration stroke is a rapid shaking of the tissues. The effect of vibration is to soothe peripheral nerves, promote relaxation, and increase blood flow. If individuals are skilled, vibration can be performed manually. If individuals are not skilled, vibration massage can be performed mechanically with a lot of different devices, such as the thumper or even a Theragun. Vibration could be utilized to invigorate an individual prior to going out to play, returning to work, performing rehabilitation, or sending a patient out of the clinic right after a massage. With vibration, please be careful. Some individuals are not comfortable with having body parts jiggled. Individuals who have more body fat can be sensitive to having certain parts jiggled. Your patient's comfort is the number one priority. Be sensitive to your patient's modesty and never embarrass your patient. Communication is the key to make sure you are working with your patient to determine the proper treatment. Different factors need to be considered prior to utilizing vibration therapy, including the age of the patient, their year in school if they're a minor, their gender or sex, the location of the massage, and how the therapist presents themselves. Remember, professionalism is key. Myofascial release involves the combination of traditional effleurage, petrissage, and friction massage with simultaneous stretching of the muscles and fascia to obtain relaxation of tense or adhered tissues and restore tissue mobility. Fascia forms an interconnected network that connects and surrounds muscles, tendons, and nerves, and separates the skin and the adipose tissue from the underlying muscle. Myofascia release attempts to restore normal function by breaking down adhesions and restoring normal fascial link. Fascia does not deform when it is exposed to a quick, high-intensity force. Fascia will, however, elongate when a slow, moderate intensity force is applied to it, an effect referred to as creep. These myofascial techniques should be followed by traditional muscle stretching techniques. Specialized training in myofascial techniques is needed to become proficient in these procedures. The J-stroke is one of the most fundamental forms of myofascial release, and it is used to mobilize superficial fascial restrictions. Skin rolling also reduces superficial myofascial adhesions. Depending upon the amount and the depth of pressure applied, focused stretching can release both superficial and deep fascial restrictions. The arm pull, leg pull, and diagonal release attempt to stretch large areas of fascia in the extremities and the torso. The flow of the massage is really up to the therapist and the patient. A common flow to follow would be to start easy, go deep, and then finish easy. We could start our strokes with effleurage. We could start these strokes by starting superficial and then working our way into deeper strokes. We could then move our strokes into petrissage, then progress to friction, then myofascial release. We could also perform vibration or tapotement between other techniques. And now we could end the treatment with effleurage again. This table is a summary of the basic massage strokes and their physiological effects. This table might be helpful in studying massage. Instrument-assisted mobilization. It can be very hard on the hands to perform massage for long periods of time and therefore using instruments to help with the massage techniques can be very helpful. These instrument-assisted mobilization techniques generally encourage realignment of scars and myofascial restrictions. There are different types and styles of instrument-assisted mobilization. Some of the most common or popular techniques include Guichat, sound-assisted soft tissue mobilization, also known as SASTM, augmented soft tissue mobilization, also known as ASTEM, and Graston. There is also another system known as Factor as well. There are many other systems that we can use as well. Why are these tools good? They cause less strain on the therapist. They can help to amplify the underlying unhealthy tissue texture. They are more efficient and shorter than manual therapy sessions. Soreness and redness, also known as petechia markings, are common after the procedures, but should go away within 24 to 48 hours. We have to be careful though. We do not want to do too much and we do not want to bruise the patient. Remember, bruising may happen, but it is not the purpose of the treatment. Bruising typically indicates that we have damaged tissues, so we would need to be extremely cautious in the following treatments. Depending upon the type, speed, and pressure of the strokes, the benefits of massage have been described as follows. It invigorates the body prior to athletic competition. It promotes relaxation prior to and after competition. It promotes blood flow to the skin, but not to deeper tissues. It decreases pain by interrupting muscle spasm and reducing edema and increasing blood and lymph flow. It activates the cutaneous receptors to close the gate to pain. It mildly promotes lymph flow, but no greater than active or passive movement of the limbs. It increases muscle flexibility following a routine of deep effleurage, circular friction, and transverse friction. Massage may aid in short-term flexibility, especially if applied to an area where an accumulation of scar tissue has resulted in a loss of range of motion. Recovery following intense, short-duration exercise is unsettled. There are conflicting research reports. Blood pressure in normotensive and prehypertensive adults. such as a blood pressure less than 150 over 95, decreased slightly. The systolic decreased by 1.8 millimeters of mercury during a 30 to 90 minute Swedish massage, but increased during vigorous and potentially painful massage techniques, such as sports massage and trigger point therapy. So we need to be aware of the effects to blood pressure. Massage carries with it a large placebo effect, so it is difficult to differentiate between the physiological and psychological effects. Here are a list of other effects massage does not have on the body as demonstrated by research. There is no effect on stride frequency or length in sprinters. Muscular fatigue is unaffected by massage. No change in cardiac output, blood pressure, or lactic acid. This hinders or does not remove blood lactate. It does not promote endorphin release. There is no increase in arterial blood flow. There is no increase in muscular temperature. Massage was no better than control treatment for relieving general anxiety disorder. And it does not cause friction between the skin and underlying fascia of the thoracic spine. Remember, your hands have a lot to say about your skills as a therapist. By using your hands to perform massage, you are communicating to the patient in a body-to-body communication. Your confidence, your thoughts, are all transmitted into your hands. You really need to be mentally and physically present when performing the massage. This takes a lot of concentration. Practice makes perfect. Practice, practice, practice. The more people you touch, the better you will be.

Massage is one of the oldest forms of a healing technique. Using therapeutic touch, the body's tissues are manipulated to reduce muscle spasm. promote relaxation, improve blood flow, and increase venous drainage. Even though massage is one of the oldest techniques that therapists utilize, it is still used in modern medicine very frequently.

There are many techniques and strokes that can be utilized in massage therapy. We will explore the strokes and the techniques that are most frequently used for therapeutic rehabilitation purposes. The term massage, massage therapy, and manual therapy are often used interchangeably and are often discussed in relation to bodywork and somatic therapy.

There are more than 250 variations of massage, bodywork, and somatic therapies. The massage community is inclusive of three groups of therapies. Massage, the application of soft tissue manipulation techniques to the body generally intended to reduce stress and fatigue. while improving circulation, body work, various forms of touch therapies that may use manipulation, movement, and or and or repatterning to affect structural changes to the body. Somatic meaning of the body.

Many times this term is used to denote a body-mind or whole-body approach as distinguished from a physiology-only or environmental perspective. Unfortunately, due to perception, sometimes performing a massage does not always look right to someone who passes by or walks past a room. Therefore, it is vitally important to always keep the perception of your treatment as professional as possible. Good communication with your patient and with others is extremely important.

Gaining consent and explaining the treatment is key to protecting yourself. Additionally, think about the setting in which you are providing treatment to your patients, and even the age or gender of your patients is something to consider. Therapists and clinicians are often required to massage different parts of the body, either on a same gender or opposite gender person. Remember, as an athletic trainer or other healthcare professional, you are not a massage therapist.

A massage therapist's sole job is to perform massages for financial gain, but the type of setting in which these massages are performed, for example, private rooms for each patient, is not always available in the therapeutic setting. Therefore, it is essential that every clinician adhere to the highest ethical standard possible when performing massage in the therapeutic setting. There is a high potential for actions during massage to be misconstrued by either the patient you are working on or by others around the patient.

Remember, perception is whatever other people think, believe, understand, or interpret a situation as. One person's perception may be different than another's and may even differ from reality, but unfortunately, people's perception is their truth. and what they believe is going on in a situation. You, as the clinician, need to make sure that you are protecting yourself first and the situation from being incorrectly perceived or perceived differently than what you intend.

People's culture, religion, background, experiences, and expectations all play into their perception. So, it is important to be aware of your surroundings and every situation is treated differently. For example, what if there was a male patient and a female therapist?

Or even vice versa, a female patient and a male therapist. Now, let's place this scenario in a private room. Does that change your perception? Maybe or maybe not. Some people would be fine with this.

Others would think that there is something wrong with this picture. or may even perceive it as inappropriate. Even though the intent of the massage is a professional one, I would highly encourage you to think about the perception that massaging someone in a private room instead of a therapeutic room is sending to others.

It is my recommendation that it is better to be safe than sorry. If you're going to perform a massage in a private room, you might want to consider having another adult present during the treatment session. In order to work with the highest standards of professionalism, I would encourage you to consider these issues when performing a therapeutic massage. Other suggestions to maintain the highest standard of professionalism include avoiding unnecessary touching and or overexposing the patient.

Consider your own personal hygiene and cleanliness. During a massage, you are in very close contact with other people. So if body odor is an issue or there is even gunk underneath your fingernails, your patient may not feel comfortable with the treatment. The same thing with wearing heavy perfume. And patient comfort is very important during this type of treatment.

Oftentimes, we need our patient to relax. Drape, drape, and drape. Please make sure to cover your patient appropriately. You should only need to expose the area that you need to work on, but I would highly encourage you to have extra towels, sheets, or even blankets in which to drape over other areas not being treated.

Draping helps to keep your patient warmer, which increases their level of comfort, and also protects their privacy. Use a spotter if needed. This person can help you place the patient in the correct position, or may just be there as a witness to the therapeutic treatment.

There is nothing harder to defend an illegal court than a he said, she said, or he said, he said, or she said, she said type of argument. Go into the massage with confidence. The more confident that you are, the more your patient can relax and get the full benefit out of the treatment. Get verbal consent prior to beginning the massage.

Please realize that in some cultures, religions, and even just some personal preferences are against personal touching. If your patient says no, then massage is not the right treatment for them, and we will have to come up with another alternative. Please remember to remove watches, rings, and to trim your long or jagged fingernails. Since you are utilizing your hands most frequently to perform massages, Anything that could scratch or be uncomfortable to the patient should be removed prior to starting the massage.

Another major issue would be to avoid any awkwardness while you are performing the massage. Sometimes bodily functions such as passing gas, having the massage lotion or oil make an awkward noise, having body parts shift across the table or stick to the table, or slipping off of a knot while you are performing a massage may occur. As a clinician, it is best just to let it go, not say anything, and move on. Eventually, it happens to all of us, and it isn't a secret that we all perform these bodily functions. It really isn't a big deal, and it is not a good idea to laugh or make comments to your patient, who may or may not be embarrassed by the situation.

If a patient says something or feels too embarrassed to continue, then you should stop the treatment immediately. Also, be careful about what you talk about during the massage. It is better to have some idle chatter, such as talking about the weather, sports, or even the news, rather than talk about personal issues.

Also, be very careful of making comments about people's anatomy or even the way they look. Many people are self-conscious. and any comments could make the situation awkward or may lead to perceptions of unprofessionalism.

Some individuals do not care, while others are highly sensitive to various situations. In order to perform a quality massage, it is imperative that you have a solid knowledge of anatomy. You need to understand when you are rubbing an area or a patient has soreness, what tissues may be affected.

Is the pain or soreness coming from muscle, tendon, fascia, or something else? What layer of muscle are you dealing with? It is also important to study touch and feel of your patients. Usually this comes from hours and hours of practice. The more people you can perform massages on, the easier it is to become comfortable and knowledgeable in the way things are supposed to feel and what is considered unusual.

or a different presentation. I would highly encourage you all to pay attention to anatomy. While I understand learning the muscle origin, insertion, action, innervation, and palpations can seem tedious, this knowledge is very important to clinicians, both within therapeutic interventions and within rehabilitation.

There are many different types of massage. The 10 most common massage techniques for athletes include Swedish massage. This is the traditional, classic, and basic massage technique and is most often what people think of for massage therapy. This technique is used for both relaxation and injury rehabilitation. Swedish massage includes different strokes including effleurage, petrissage, friction, tapotement, and vibration.

all of which will be covered. Sports massage. This is the application of Swedish massage techniques to athletes and others involved in physical activity.

The focus is on preventing and treating injuries to enhance athletic performance. Research has provided mixed support for the use of massage to aid in muscle recovery or performance after intense exercise among case series and randomized controlled trials. Myofascial release, also known as MFR.

This is light sustained pressure that is applied in the opposite direction, allowing for tissues to be gently stretched and release of myofascial restrictions that inhibit movement or cause pain. Graston. This is an instrument-assisted soft tissue mobilization method that requires specific training and certification. The stainless steel instruments are designed with a unique curvilinear treatment edge, contoured to fit various shapes of the body, rolfing or structural integration, this is vigorous deep tissue massage, and myofascial release to restore normal body alignment, structure, and function.

A key principle is that fascial contractures result from chronic dysfunction movements and imbalance muscular tension, resulting in pain and lessened muscle and joint motion. The body must be released from these learned patterns and mal-aligned structures. Neuromuscular therapy or NMT.

Practitioners address comprised or entrapped nerves by osseous or myofascial structures, trigger points, postural distortion or imbalance, emotional factors, and ischemia and nutritional deficiencies. A variety of techniques are used, including trigger point pressure release, cryospray, needling, and myofascial release. Proponents suggest that it improves functioning of the immune system, glands, joints, muscles, and related soft tissues.

Shiatsu. This is a form of Japanese pressure point therapy, similar to trigger point therapy, but concentrates on the application of pressure to acupuncture points. One specific type of shiatsu massage is known as prenatal or postpartum massage. Specific strokes and positions are used with women to address muscular issues that occur secondary to pregnancy.

Craniosacral therapy or CST. This is a gentle, hands-on method of enhancing the craniosacral system, the spine and the membranes, and the cerebrospinal fluid that surrounds and protects the brain and spinal cord. The goal.

is to improve the central nervous system by releasing restrictions of the cranial sacral system. Trigger point therapy. This therapy includes repetitive cycles of isolated pressure and release over a trigger point.

A trigger point is a painfully tight area in a muscle caused by muscle overuse or injury. Reflexology. This treatment involves the application of fingers and thumb pressure. to specific reflex areas of patients'hands and feet that are thought to correspond to all of the glands, organs, and parts of the body.

Advocates claim this treatment helps to promote the unblocking of nerve impulses and helps nature achieve homeostasis. Depending upon the stroke of the massage, it may require the use of lubricants to increase the comfort for the patient. There are many different types of lubricants including powders, creams, and oils.

The amount of lubricant needed depends upon the technique and the strokes that will be utilized during the treatment. One of the most important things to consider when performing the massage is both the patient and the clinician comfort. You will have to decide whether you want your patients to lay supine, prone, or prone to side-lying, or even sitting upright for the massage.

Making sure that your patient can breathe, can relax, and is comfortable during the entire massage is very important to the treatment. These are many examples of different tools that can prop, support, or allow your patient to be massaged in comfort. The prone pillow allows the patient to lie prone with the head straight. There are ventilation channels that allow for fresh air to get to the patient's face during the massage.

In some instances, a prone table can be used that has a prone pillow as an attachment. You may also want a patient to be seated and therefore there are massage chairs available. In addition, the use of movable wedges and bolsters can help make your patient comfortable. during the massage. Certain conditions may require that a patient not lay flat on their back such as pregnancy and severe obesity among other conditions.

Therefore, having your patient in a side-lying position may be an option as well. In addition to patient comfort, as a clinician, you may be performing the massage for a while. Therefore, it is vital that you use good posture as well.

Whenever possible, use large muscle groups which will allow you to use your body weight to perform massages or can allow you to support yourself well during a massage. I would encourage the use of an adjustable height table as well when possible. Invest in a stool that can allow you to adjust your height to the table so that you can work at the best angle possible.

I would encourage you not to lean over the table as your low back will not appreciate it. and typically the massage will be cut short as your body cannot stay in this position long before starting to hurt. Pick the right table height so that you can use your body to work efficiently.

If you cannot readjust the table, then readjust yourself. Get a stool or maybe even kneel on the table. You need to make sure that you as the clinician are not injuring yourself while you're trying to treat others. Massage can be very tiring to the hands, depending upon the strokes.

You can utilize different parts of the hands so you don't get so tired. The most common parts of the hand utilized for massage therapy are the entire palmar surface, hypothenar eminence, thenar eminence, the heel of the hand, the fingertips, finger pads, knuckle, fist, elbow, and the list goes on. You can be creative.

If you are going to use massage tools, make sure that they are the right ones. They should not be wooden kitchen spoons. For a little laugh, check on Blackboard. There is a clip from an old Friends episode in which the wrong tools are being utilized for massage. While this clip has hilarious results, it is important that we are using the right tools and being professional at all times.

Also, please make sure that your pressure and your touch is a friendly one. Just because you personally like more pressure does not necessarily mean that all of your patients do. Be sure to communicate with your patient to make sure that they are comfortable during the treatment.

Looking at a patient's face during the treatment can also help you determine if the pressure is good. Some of you have very bony fingers, so just be aware of that while you're performing the massage. Massage techniques are utilized for many different purposes.

Some of the most common uses for massage include painful conditions of musculoskeletal origins, muscle strains, muscle spasms, myofascial adhesions, and trigger points. Fascia is a band or sheet of connective tissue, primarily collagen, beneath the skin that attaches, stabilizes, encloses, and separates muscle and other internal organs. Fascia is classified by layer. as superficial fascia, deep fascia, and visceral or parietal fascia, or by its function and anatomical location.

Fascia are similar to ligaments and tendons as they have collagen as their major component. They differ in their location and function. Ligaments join bone to another bone, tendons join muscle to bone, and fascia surrounds muscles and other structures.

Fascia is made up of fibrous connective tissue containing closely packed bundles of collagen fibers oriented in a wavy pattern parallel to the direction of pull. Fascia is consequently flexible and able to resist great unidirectional tensional force until the wavy pattern of the fiber has been straightened out by the pulling force. These collagen fibers are produced by fibroblasts located within the fascia. Fascia is located pretty much everywhere in the body and has a spider web-like appearance.

The physiological effects associated with massage include vasodilation or an increased blood flow. During massage, histamine is released which causes an increase in the body and tissue temperature. There is an increased venous and lymphatic return, and also a sedation or decreased activity of the nerve endings, which could reduce pain perception. There is also an associated elongation of muscle, fascia, and the capsule, which may help to decrease the effects of delayed onset muscle soreness, or DOMS. Depending upon the type of massage, relaxation, decreased heart rate, decreased respiratory rate, and a decrease in blood pressure are also seen.

For many people, massage creates a general feeling of well-being. Never underestimate the power of a healing touch. Humans are not the only ones who participate in massage to feel good. Cats will massage each other too.

See cat massages, they really do exist. Massage affects tissue through four primary effects, biomechanical, physiological, neurological, and psychological. The biomechanical effect of massage comes from the mechanical pressure on the tissues. This results in decreased tissue adhesion, increased muscle compliance, increased joint range of motion, decreased passive stiffness, and decreased active stiffness of the muscles. The physiological effect of massage comes from the changes in the tissue or the organ.

This results in an increase in muscle blood flow, increased skin blood circulation, increased parasympathetic activity. Increased relaxation hormones and decreased stress hormones being released. The neurological effect of massage comes from the reflex stimulation.

This results in a decrease in the neuromuscular excitability, decreased pain, and decreased muscle tension or spasm. The psychological effect of massage comes from the increased relationship between body and mind. This results in an increase in relaxation. and a decrease in overall anxiety. The indications, precautions, and contraindications of massage.

The primary indication for the use of massage includes edema reduction, muscle spasm, scar tissue, myofascial adhesions, decreased range of motion, and increased muscle tone. The precautions for the use of massage include impaired sensation. To remedy this, we can apply decreased pressure. but we still need to be careful.

We also need to be aware of patients who have hypertension. Depending upon the stroke that we are using in massage, blood pressure could potentially rise. The contraindications for the use of massage include acute injuries and areas of active inflammation.

We do not want to increase any inflammation in the area. Open skin lesions or dermatological diseases, vascular disease such as blood clots, infections, unhealed fractures, and people who are hypersensitive to touch. There are multiple strokes that are associated with massage.

For the sake of this lecture, we will focus on the most common ones, which include effleurage, petrissage, friction, tapotement, and vibration. Myofascial release is a different type of massage, but is commonly used in the sports setting, just like Swedish massage or sports massage. Effleurage is a stroking of the skin. We typically use effleurage to warm the patient up to our touch and to gauge areas of tightness within the patient. All effleurage strokes are performed in a rhythmic manner.

Strokes should be directed towards the heart. The thumbs can be used to fit into anatomical contours such as between the toes or behind the malleoli. Lastly, at least one hand should be in contact with the patient at all times.

Superficial stroking stimulates the tissues and encourages blood flow if done fast. Slow superficial stroking promotes relaxation of the patient. Deeper stroking stimulates deeper tissues and forces fluids in the direction of the stroke. We typically use effleurage at the beginning and the end of massage treatments. It can also be used between petrissage strokes to make the patient more comfortable.

At the beginning of the massage, we are introducing our hands to the patient. This stroke helps to relax the patient and to scan the area for tightness. At the end of the massage, we use effleurage to calm down irritated nerves.

Here are some examples of effleurage. Please also watch the associated YouTube videos on Blackboard for more insight on the stroke. Petrissage is similar to kneading dough.

Petrissage is the lifting, kneading, and rolling of the skin, subcutaneous tissue, and the muscle with the fingers or the hands. This stroke is similar to myofascial skin rolling. Petrissage targets the underlying muscle and is particularly useful in superficial, mobile muscles such as the upper trapezius or the forearm muscles. Petrissage frees adhesions by stretching and separating muscle fibers, fascia, and scar tissue. This technique milks metabolic waste products, assists in venous return, and can lead to muscular relaxation.

Here are some examples of petrissage. Please also watch the YouTube videos on Blackboard for more insight on this stroke. The tapotement stroke is a gentle tapping, wrapping, or pounding on the skin.

Tapotement promotes muscular and systemic relaxation. It also desensitizes irritated nerve endings. Tapotement is often used following vigorous techniques such as friction or petrissage. Tipotment may also be used when you are trying to get the patient to relax and may be performed over clothing.

Different forms of tipotment include cupping in which the hands are cupped when striking the skin, hacking in which the lateral side of the hands are used to strike the skin, and even pinching where the skin is sort of gently pinched. Another technique is slapping in which the skin is gently slapped to form a percussion. Here are some examples of tapotement. Please also watch the YouTube videos on Blackboard for more insight on the stroke. Friction massage mobilizes muscle fibers and separates adhesions on muscles, tendon fibers, or scar tissue that restrict motion and cause pain, and it is used to facilitate local blood perfusion.

There are two primary types of friction massage, circular and transverse. also known as cross friction or cross fiber massage. Circular friction massage occurs with the two thumbs moving over a small area in a circular motion.

Circular friction massage is great for treating muscle spasms, trigger points, and scar tissue. The transverse or cross fiber massage occurs when the thumbs or fingertips are moved in the opposite direction. The treatment is typically performed by the patient. perpendicular to the tissue being treated. Transverse massage is great for treating muscle spasms, trigger points, and motor points.

This massage stroke is most often used for tendinitis. Here are some examples of friction massage. Please also watch the YouTube videos on Blackboard for more insight on the stroke. Vibration stroke is a rapid shaking of the tissues. The effect of vibration is to soothe peripheral nerves, promote relaxation, and increase blood flow.

If individuals are skilled, vibration can be performed manually. If individuals are not skilled, vibration massage can be performed mechanically with a lot of different devices, such as the thumper or even a Theragun. Vibration could be utilized to invigorate an individual prior to going out to play, returning to work, performing rehabilitation, or sending a patient out of the clinic right after a massage. With vibration, please be careful.

Some individuals are not comfortable with having body parts jiggled. Individuals who have more body fat can be sensitive to having certain parts jiggled. Your patient's comfort is the number one priority. Be sensitive to your patient's modesty and never embarrass your patient.

Communication is the key to make sure you are working with your patient to determine the proper treatment. Different factors need to be considered prior to utilizing vibration therapy, including the age of the patient, their year in school if they're a minor, their gender or sex, the location of the massage, and how the therapist presents themselves. Remember, professionalism is key.

Myofascial release involves the combination of traditional effleurage, petrissage, and friction massage with simultaneous stretching of the muscles and fascia to obtain relaxation of tense or adhered tissues and restore tissue mobility. Fascia forms an interconnected network that connects and surrounds muscles, tendons, and nerves, and separates the skin and the adipose tissue from the underlying muscle. Myofascia release attempts to restore normal function by breaking down adhesions and restoring normal fascial link. Fascia does not deform when it is exposed to a quick, high-intensity force.

Fascia will, however, elongate when a slow, moderate intensity force is applied to it, an effect referred to as creep. These myofascial techniques should be followed by traditional muscle stretching techniques. Specialized training in myofascial techniques is needed to become proficient in these procedures.

The J-stroke is one of the most fundamental forms of myofascial release, and it is used to mobilize superficial fascial restrictions. Skin rolling also reduces superficial myofascial adhesions. Depending upon the amount and the depth of pressure applied, focused stretching can release both superficial and deep fascial restrictions. The arm pull, leg pull, and diagonal release attempt to stretch large areas of fascia in the extremities and the torso.

The flow of the massage is really up to the therapist and the patient. A common flow to follow would be to start easy, go deep, and then finish easy. We could start our strokes with effleurage.

We could start these strokes by starting superficial and then working our way into deeper strokes. We could then move our strokes into petrissage, then progress to friction, then myofascial release. We could also perform vibration or tapotement between other techniques. And now we could end the treatment with effleurage again. This table is a summary of the basic massage strokes and their physiological effects.

This table might be helpful in studying massage. Instrument-assisted mobilization. It can be very hard on the hands to perform massage for long periods of time and therefore using instruments to help with the massage techniques can be very helpful.

These instrument-assisted mobilization techniques generally encourage realignment of scars and myofascial restrictions. There are different types and styles of instrument-assisted mobilization. Some of the most common or popular techniques include Guichat, sound-assisted soft tissue mobilization, also known as SASTM, augmented soft tissue mobilization, also known as ASTEM, and Graston. There is also another system known as Factor as well.

There are many other systems that we can use as well. Why are these tools good? They cause less strain on the therapist.

They can help to amplify the underlying unhealthy tissue texture. They are more efficient and shorter than manual therapy sessions. Soreness and redness, also known as petechia markings, are common after the procedures, but should go away within 24 to 48 hours. We have to be careful though. We do not want to do too much and we do not want to bruise the patient.

Remember, bruising may happen, but it is not the purpose of the treatment. Bruising typically indicates that we have damaged tissues, so we would need to be extremely cautious in the following treatments. Depending upon the type, speed, and pressure of the strokes, the benefits of massage have been described as follows.

It invigorates the body prior to athletic competition. It promotes relaxation prior to and after competition. It promotes blood flow to the skin, but not to deeper tissues. It decreases pain by interrupting muscle spasm and reducing edema and increasing blood and lymph flow.

It activates the cutaneous receptors to close the gate to pain. It mildly promotes lymph flow, but no greater than active or passive movement of the limbs. It increases muscle flexibility following a routine of deep effleurage, circular friction, and transverse friction.

Massage may aid in short-term flexibility, especially if applied to an area where an accumulation of scar tissue has resulted in a loss of range of motion. Recovery following intense, short-duration exercise is unsettled. There are conflicting research reports. Blood pressure in normotensive and prehypertensive adults. such as a blood pressure less than 150 over 95, decreased slightly.

The systolic decreased by 1.8 millimeters of mercury during a 30 to 90 minute Swedish massage, but increased during vigorous and potentially painful massage techniques, such as sports massage and trigger point therapy. So we need to be aware of the effects to blood pressure. Massage carries with it a large placebo effect, so it is difficult to differentiate between the physiological and psychological effects.

Here are a list of other effects massage does not have on the body as demonstrated by research. There is no effect on stride frequency or length in sprinters. Muscular fatigue is unaffected by massage. No change in cardiac output, blood pressure, or lactic acid.

This hinders or does not remove blood lactate. It does not promote endorphin release. There is no increase in arterial blood flow.

There is no increase in muscular temperature. Massage was no better than control treatment for relieving general anxiety disorder. And it does not cause friction between the skin and underlying fascia of the thoracic spine.

Remember, your hands have a lot to say about your skills as a therapist. By using your hands to perform massage, you are communicating to the patient in a body-to-body communication. Your confidence, your thoughts, are all transmitted into your hands. You really need to be mentally and physically present when performing the massage.

This takes a lot of concentration. Practice makes perfect. Practice, practice, practice. The more people you touch, the better you will be.

Transcript for:Understanding Therapeutic Massage Techniques

Transcript for:
Understanding Therapeutic Massage Techniques