Massage Therapy

History of Massage

Natural reaction to when the body hurts is to rub it Dates back to at least the ancient Olympics In Europe in the Middle Ages, the Church of Rome & its religious teachings discouraged massage as a healing practice Massage is derived from 2 sources

Arabic verb mass to touch Greek word massein to knead

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

History of Massage

Sweden early 19th century, Peter Ling (acknowledged founder of curative gymnastics) appears to be founder of modern day massage techniques, incorporated with French massage techniques Techniques have changed dramatically in the past 50 years

Based on research by Albert Hoffa (1859-1907), James Mennell 1880-1957), & Gertrude Beard (1887-1971). Scientific basis to massage was added Late 1980s, Amer. Massage Therapy Association was organized (1992 Natl Cert. Exam. For Therapeutic Massage & Bodywork was formed)

What is Massage Therapy?

Mechanical modality Used to manipulate the bodys tissue Effective in promoting local & systemic relaxation, increasing local b. flow, breaking down adhesions, & encouraging venous return Act of rubbing, kneading, or stroking the superficial parts of the body with the hand or an instrument for the purpose of modifying nutrition, restoring power of movement or breaking up adhesions Time-consuming

Treatment Considerations & Guidelines

Need to know underlying pathology Need to know basic massage principles (must have manual dexterity, coordination, & concentration). Must also exhibit patience & courteousness. Hands must be clean, warm, dry & soft. Nails must be short and smooth. Hands should be warm. Avoid constant hyperextension or hyperflexion of any joints which may lead to hypermobility. Must obtain correct positioning that will allow for relaxation, prevent fatigue & permit free movement of arms, hands, & body.

Treatment Considerations & Guidelines

Must obtain good posture to prevent fatigue & backache. Weight should be evenly distributed on both feet. You must be able to fit your hands to the contour of the area being treated. A good position is required to allow for correct application of pressure and rhythmic strokes during the procedure.

Points for Consideration

Pressure regulation should be determined by the type & amount of tissue present. Also, pressure is governed by the condition & which tissues are affected. Each stroke must have equal pressure & time (rhythm present). Duration depends on pathology, size of area, speed of motion, age, size, & condition of athlete. Also, massage may not be warranted on a daily basis (e.g. friction massage).

Some areas may take 30 minutes.

Points for Consideration

If swelling is present in an extremity, treatment should begin proximally.

Uncorking the bottle, uncorking effect

Massage should never be painful, except possibly for friction massage. It should not cause ecchymosis. Direction of forces should be applied in the direction of the muscle fibers. Each session should begin & end with effleurage.

Points for Consideration

Make sure the patient is warm and in a comfortable, relaxed position. Also, make sure the patient is properly draped. The body part may be elevated if necessary. Massage should begin with superficial stroking. Each stroke should start at the joint or just below the joint (unless contraindicated) and finish above the joint so that strokes overlap. Pressure should be in line with venous flow. Bony prominences & painful joints should be avoided if possible.

Massage Media

Used to decrease friction between the patients skin and the clinicians hand

Massage can be given without any medium being used

Lotions, peanut oil, powder, analgesic balms

More medium should be used on hairy areas

During petrissage lubricants interfere with the kneading & lifting During friction massage lubricants may interfere with the certain results you want to obtain

Massage Strokes

Effleurage Petrissage Friction (circular, transverse) Tapotement Vibration Myofascial release techniques Various other forms some may combine strokes

Physiological Effects of Massage Therapy

Depending on the amount of pressure applied & the speed of the stroke, many results can occur

Light, slow stroking evokes systemic relaxation Fast, deep strokes increase blood flow to the area

Cardiovascular changes deep friction or vigorous

Physiological Effects

Petrissage has been shown to decrease neuromuscular excitability, but only during the massage (effects confined to muscle being massaged) Deep effleurage, circular & transverse friction has shown to improve flexibility Massage is less effective in decreasing muscular recovery time, but may be effective (2 hrs post) in reducing amount of DOMS

Little reduction in m. fatigue when performing between exercise (pitcher, sprinter)

Physiological Effects

Edema reduction when performed properly it can increase venous & lymphatic flow Reduces pain

By decreasing pressure from swelling, mechanical pain can be reduced By interrupting m. spasm, mechanical pain can be reduced By reducing edema, mechanical pain can be reduced By increasing b. flow & encouraging waste removal, chemical pain can be reduced Activates sensory nerves inhibits pain

Mechanical Effects

Techniques that stretch a muscle, elongate fascia, or mobilize soft-tissue adhesions or restrictions are all mechanical techniques Mechanical effects are always accompanied by some reflex effects

As mechanical stimulus becomes more effective, reflex stimulus becomes less effective

Muscle massage is done either for mechanical stretching or to relieve pain associated with trigger points

Mechanical Effects

Skin massage has been shown to increase skin temperature, increase sweating & decrease resistance to electrical current It has been shown to toughen yet soften the skin Acts directly on the surface of the skin to remove dead cells Stretches & breaks down fibrous tissue

Psychological Effects

One-on-One treatment Reduces patient anxiety, depression, & mental stress Patient compliance is increased Patient gains confidence in clinician

Effleurage

Stroking of the skin Performed with palm of hand

Stimulates deep tissues Stimulates sensory nerves Contours the body or relates to direction of underlying muscles Follows course of veins & lymph vessels

Performed with fingertips

Superficial, rhythmic stroking:

Deep stroking:

Effleurage

May be performed slowly for relaxation or rapidly to encourage blood flow & stimulate the tissues Performed in rhythmic manner One hand should always be in contact w/ skin Light effleurage is performed at beginning & end of massage or may be used between petrissage strokes

At beginning relaxes patient & indicates area to be treated At end calms down any irritated areas

Petrissage

Lifting & kneading of skin, subcutaneous tissue, & muscles Performed with fingers or hand Skin is gently lifted between thumb & fingers or fingers & palm & gently rolled & kneaded in the hand Often performed without lotion Frees adhesions by stretching & separating muscle fiber, fascia, & scar tissue while assisting with venous return & milking out waste products

Friction

Goal is to mobilize muscle & separate adhesions that restrict movement & cause pain Facilitates local blood profusion Not necessarily a pleasing treatment Circular:

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

Friction

Transverse:

Applied with thumbs or fingertips stroking the tissue from opposite directions Can use elbow, end of rolling pin, etc. for larger areas Reaches deep tissues Begin lightly and then move to firmer strokes Muscle should be placed in relaxed position Should be avoided in acute conditions Effective in tendonitis or other joint adhesions

Tapotement

Gentle tapping or pounding of the skin Most common form uses ulnar side of wrist to contact skin karate chop Wrist & fingers are usually limp, alternate method cups the hand Promotes relaxation & densitization of irritated nerve endings

Vibration

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

Myofascial Release

Involves effleurage, petrissage & friction massage strokes with stretching of muscles & fascia Tries to obtain relaxation of tense and/or adhered tissues (myo muscle; fascia band; ease the tension of fibrous CT bands) No structured pattern Involves pulling of tissues in opposite directions, stabilizing the proximal/superior position w/ one hand while applying a stretch w/ opposite hand, or using the patients body weight to stabilize the extremity while a longitudinal stress is applied Can involve more than one clinician

Myofascial Release

Purpose is to relieve soft tissue from abnormal grip of tight fascia May also be known as soft-tissue mobilization Treatment is based on localizing the restriction & moving into the direction of the restriction Very subjective & relies on experience of clinician Recommended to treat at least 3 x per week

Acupressure

Acupressure based on Chinese art of Acupuncture The Chinese make no distinction between arteries, veins, or nerves when explaining function of the body.

Concentrate on the system of forces that regulate all bodily functions.

Qi (pronounced che exists in everyone & controls all aspects of life)

Qi is governed by two opposing forces, Yang (positive) & Yin (negative) forces. Disease results from some imbalance between these two forces. Yin & Yang pass flow through passageways/lines in the body called jing (Chinese) or meridians (West).

Acupressure

12 meridians in the body named according to the part of the body with which they are associated. The meridians on one side of the body are duplicated on the other side; however, two additional meridians exist that cant be paired.

*not paired

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

Acupressure

Along the meridians lie the acupuncture points

Whenever there is pain or illness, certain points on the surface of the body become tender When pain is eliminated, these tender spots disappear

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

Acupressure

Electrical resistance of the skin at certain points corresponding to the acupuncture points is lower than that of surrounding skin, especially when a disease state is present. Russian research has shown evidence of skin temperature difference at these points.

Myofascial Trigger Points

Trigger points are the counterpart of acupuncture points May be found in muscle, tendons, myofascia, ligaments & capsules surrounding joints, in periosteum, & in the skin May activate & become painful due to trauma Stimulation of these points have resulted in pain relief

What to do.

Location of points: Use an ohmmeter to differentiate the electrical impedance of areas OR palpate the area until either a small fibrous nodule or strip of tense muscle tissue that is tender to the touch is felt. Once located, massage is begun using the thumb, index or middle fingers or the elbow. Perform small friction-like circular motions over the point. Amount of pressure should be determined by patient tolerance, and may be intense and painful. Treatment time 1-5 minutes at a single point. Patient will report a dulling/numbing effect & will report the pain diminishes.

Rolfing

May also see it is structural integration Goal - to balance the body within a gravitational field through a technique involving manual soft-tissue manipulation

Improve balance, posture, flexibility, movement efficiency Basic principle of treatment is - if balanced movement is essential at a particular joint, yet nearby tissue is restrained, both the tissue & the joint will relocate to a position that accomplishes a more appropriate equilibrium.

Rolfing

Standardized approach that is administered without regard to symptoms or pathologies Technique involves 10 hour-long sessions, each emphasizing some aspect of posture 10 sessions include:

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

Additional tune-up sessions may be required Integrates structural with psychological approach

Underwater Pressure Massage

The therapeutic benefit of the underwater massage comes from the relaxing effect of warm water, applied at variable force on the muscles, particularly on deep-lying muscle layers, subcutaneous tissues, skin and the abdominal organs (intestines).

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In the underwater massage, the client lies relaxed in a large tub of warm water. A stream of water under pressure, (ranging from 0.5 to a maximum of 7.0 bar absolute pressure units), is applied by means of a hose that has interchangeable nozzles. The water needed for the massage is drawn from the tub and returned under pressure through the hose. The high-pressure stream of water is created by an internal pump.

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WATER TEMPERATURE The temperature of the water in the tub should be 36o C; (96.8 o F to 100.4 o F). The temperature of the pressurized stream can be adjusted to a higher or lower temperature than the water in the tub. The water temperature is precisely measured by a built-in thermometer.

PRESSURE CONTROL

Pressure is controlled by a manometer. However, because the stream of pressurized water has to travel through the water in the tub, the pressure shown on the manometer is not necessarily the pressure that is felt by the client. For clients who have sensitive tissue such as track and field athletes one must begin with low water pressure (0.5-1.5 bar), and raise the pressure slowly. Conversely clients with large muscle mass, such as heavyweight wrestlers and boxers, can usually withstand higher water pressures (2.0-4.0 bar).

TREATMENT POSITIONS

When massaging the back the client is always lying on their side. In this position, the hips and knees are slightly bent, the head and neck rest on a support The thorax and the abdomen are massaged with the client in the supine position

LENGTH OF MASSAGE

Generally, the length of a massage is 20 to 30 minutes. Its necessary for the person to get used to the water for a few minutes before starting the massage. After the massage, the client may want a cold affusion to stimulate circulation. The client should then rest for approximately 30 minutes.

INDICATIONS

Fractures Osteosynthesis Dislocation Sprains Contusions in the subacute stages after a patient has been released Sciatica Lumbalgia Brachialgia Joint and Scar contractures

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Degenerative Spinal Disorders Chronic Joint Rheumatism Muscular Rheumatism Bechterevs Disease (ankylosing spondylitis) Scoliosis Flaccid and Spastic Paralyses The underwater massage can also be utilized for muscular hypertonia and for uninjured athletes as a warm-down massage after strenuous training and competition.

CONTRAINDICATIONS

The underwater massage is contraindicated for cardiovascular insufficiencies venous disorders thromboses varices.

ABOUT THE TUB

An easy to operate modern bathtub, the bathtub assembly is made of reinforced fibre, polyester-resin casting (GFK), especially tempered to provide heat and shock resistance. The surface will resist thermal and seawater, plant extracts and chemicals. All surfaces are smooth and free of pores making the tub hygienic and easy to clean. The water pump is noiseless, enclosed in a plastic casing with a conveying efficiency of 2001/min., infinitely variable from 0 to 6 bars. All fittings are chrome plated.

DEEP CONNECTIVE TISSUE MASSAGE

Deep connective tissue massage is a form of intense massage that aims to release myofascial (connective tissue) restrictions in the body, and to break up any restrictive scar tissue. It has also been known to help relieve chronic tension, to increase the bodys range of motion, to improve posture and to enhance the natural harmony of the entire body and mind Deep connective tissue massage is also said to restore the length and flexibility to the fascia

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Deep connective tissue massage borrows many of its techniques from traditional Swedish massage. However the pressure that a massage therapist applies during a deep connective tissue massage is more intense, and massage oil or lotion isnt typically used