MASSAGE

• Soft tissue mobilization (massage)

  The systematic and scientific manipulation of body tissues for remedial or restorative purposes
• Types of soft tissue mobilization

  • Effleurage
  • Kneading
  • Friction
  • Percussion
  • Vibration
• Effleurage


  Stroking, light or heavy, of the skin surfaces
• Superficial stroking


  • Aims only to produce a reflex effect
  • Must be performed slowly, gently and rhythmically
• Deep stroking


  • Produces a mechanical effect on the veins and lymphatic vessels, and hastens the movement of their contents in physiologic directions
• Essentials for deep stroking

  • To have the patient's muscles relaxed
  • To take advantage of gravity, especially if edema is present
  • To make pressure deep but not too heavy
  • Massage in the direction of the venous and lymph flow
• Kneading


  • Deep kneading and squeezing of the superficial fascia and underlying muscles
  • Amount of pressure is intermittent as contrasted to effleurage
  • Tissues in the hand are repeatedly grasped and released with varying degrees of pressure
  • Produces mechanical effect on deep veins & lymphatics
  • Assists in removing lactic acid, metabolites, and relieves congestion by reducing the edema and fibrin formations
• Friction


  • Deep pressure movements against a hard underlying surface
  • The thumb and fingers are kept in firm contact with the skin; the skin and superficial tissues are moved in a circular direction over the underlying structures
• Purpose of friction movements

  • Looses adherent scars, and to free adhesions of deeper parts such as tendons of the hand and foot
  • To aid in absorption of local effusion
  • To be used over joint surfaces

  
• Percussion


  Scientific application of hacking, clapping, and beating to secure stimulating effects through nerve endings
• Lubricants for massage


  • Unscented talcum
  • Mineral Oil (or mineral oil and alcohol 3:1)
  • Peanut oil
  • Cold cream
  • Baby oil
  • Cocoa butter
• Position and support for massage


  • Position of choice is that which is optimal to the patient's comfort and physiological or orthopedic disability
  • Drape the patient, exposing only the part to be massaged
  • Always explain what you are going to do to the patient and why
  • Always support the part as it aids in relaxation, aids flow of venous and lymphatic fluids, and reduces edema by gravity assisting

  
• General rules for massage

  • Do not cause pain by massage
  • Avoid fatigue. Local massage: 10-20 minutes. General: 30-45 minutes
  • In massaging an immobilized limb, be careful not to change the position or to stretch the injured part
  • Fingers and hands should be flexible. They should be kept in contact with each other, with only the thumb separated from the index finger
  • Use a lubricant best suited to the part

  
• Contraindications for massage


  • Elevation of temperature—precautionary sign
  • Skin diseases
  • Active infections—osteomyelitis,etc
  • Malignancies—possibility of metastasis
  • Abdominal massage in pregnancy
  • Debilitating diseases
  • Neurotic pain—may fix neurosis
  • Any condition which will result in worsening of the patient's signs and symptoms
• Edema


  A type of swelling caused by trapped fluid within the body's tissues
• Temporary conditions of edema may occur to most people at some point in their lifetime, and may be easily treated by massage therapy</b>
• Normally, the body removes excessive fluid before it builds up, but there are several factors that may lead to edema
• Types of edema


  • Temporary edema (can be treated by massage)
  • More serious forms of edema (no massage, seek physician's diagnosis & treatment)
• How massage therapy works for edema

  Massage therapy works by directing pressure at the skin and muscle areas affected by edema. The lymphatic system is activated during the process and the fluid drains away naturally.

  
• Manual lymphatic drainage


  A special type of massage introduced by Emil Vodder, a Danish massage practitioner. It involves employing the lymphatic system to drain fluids from the area affected by edemas.
• Basic principle of manual lymphatic drainage

  • Involves massaging the body parts nearer (proximal) to the heart before the parts farther away (distal). This clears the path for the flow of fluids when the distal parts are massaged.
• After a manual lymphatic massage, the area affected by the edema should be wrapped in low-stretch bandages to support the connective tissue and maintain constant pressure that inhibits further fluid accumulation.
• Preparations for massage laboratory practice

  • Determine the procedure to be used (patient position, techniques)
  • Have all materials ready (pillows, towels, massage lubricant)

  
• Treatment considerations for massage laboratory practice

  • Your position and body mechanics are important
  • Your hands should be washed, nails short and clean, no rings or watch
  • Explain the procedure to the patient
  • Position the patient comfortably and supported
  • Drape the patient
  • Check the patient's skin and ask about lubricant sensitivity
  • Choose the proper lubricant
  • Choose the proper massage technique
  • Treatment time can vary
  • End with light effleurage
  • Remove lubricant and allow patient to dress

  
• Steps for manual lymphatic drainage

  • Raise the limb affected by edema for 10-15 minutes
  • Start massaging strokes from the proximal parts towards the lymph drainage areas (axilla, groin)
  • Recommend passive and active exercises to improve blood and lymph flow
• Effleurage/stroking techniques


  • One-handed raking
  • One-handed ironing
  • One-handed circular
  • Two-handed heart
  • Two-handed circular
  • Alternate hand raking
  • Alternate hand circular (sun-moon)
  • Nerve stroke

  
• Glide


  Deeper the glide, the slower the movement
• Technique


  Calms the nervous system when done slowly
• One-handed circular


  • Can be performed around the shoulder, hip, knee and abdomen
  • Provides relaxation and prepares an area for a deeper stroke
• Two-handed heart


  • Performed up and down for the back in a heart shape pattern, up the leg or up the arm
  • Increases blood and lymph circulation and provides relaxation
• Two-handed circular


  • One hand may be placed next to or on top of the other hand
  • Relieves insomnia
• Alternate hand raking


  • The index and middle fingers form a letter V and may be placed on either side of the spine
  • Used to move from one side of the plinth to the other without losing contact with the treated area

  
• Alternate hand circular (sun-moon)


  • Can be performed as one-hand circles a region and the other hand moves behind the first hand in a semi-circle or crescent shape
• Nerve stroke


  • Considered as light effleurage
  • Feather light, like fingers tracing over the skin
  • Used as a finishing stroke; typically done at the end of treatment of a body segment and at the completion of massage
• Effleurage


  Basic stroke
• One-handed petrissage/kneading


  • The entire hand or the pads of the fingers and thumb can be used to lift the tissue
  • Well-suited for smaller muscular areas such as the arms, top of trapezius, or arms and legs of a child
  • Fingers are lifting, compressing and releasing the tissue simultaneously
  • Often used to address larger muscular areas at the back

  
• Fulling


  • Grasp the tissue with both hands; lift it up and away from the bone while spreading it out laterally
  • Repeat the movements until the tissues feel warm and elastic
  • Effective for broadening muscles and their related tissues and mimics muscle contraction
• Two-handed ocean waves


  • Uses a back and forth movement while the hand opposes each other, lifting the sides and pressing down while on top
  • Typically applied across a larger muscular area or horizontally down the back
• Alternate hand petrissage/kneading


  • Lift the skin and underlying tissue with one hand and compress
  • Next is lighten the grip enough to allow the muscle tissue to be released while still remaining in contact with the skin
  • Repeat the first move with the opposite hand
  • Do not lose contact with the skin while switching hands
  • It is done to stimulate the nervous system and improve cellular nutrition

  
• Two-handed praying hands petrissage/kneading


  • Fingers are interlaced in a praying hand position
  • Helps maintain proper position of treated area