Massage Techniques

Question 1

What are the goals of massage therapy

Answer 1

enhance tone and tissue extensibility

increases blood flow (deep)

increases cutaneous temperature (deep)

Question 2

What does massage effects

Answer 2

1. nervous
2. muscular
3. circulatory
4. lymphatic

Question 3

What are GENERAL PRINCIPLES of massages

Answer 3

1. Start superficial, and then go deep… this warms up area/tissue, increase blood flow and extensibility before going deeper
2. start non-specific and then become more specific
3. end with general/broad strokes … this helps relax the patient and increase blood flow

Question 4

What are the Benefits of Effleurage

Answer 4

1. Warms tissues due to mild erythema,
   decreases pain, reduces muscle tension
2. slow technique - no more than 15 strokes
   per minute

Question 5

How to do Petrissage (fancy term for kneading/pinching)

Answer 5

1. Grasp the skin and underlying muscle tissue while applying cross-fibre stroking or stretching
2. Alternating traction, squeezing and relaxing of a localized mass of tissue between thumb and fingers

Question 6

What are the Benefits of Petrissage (hands in a C position or crab hands)

Answer 6

1. Improves tissue fluid exchange and vascularity
2. reduces swelling and fluid accumulation
3. creates hyperemia
4. improves elasticity and contractility of connective tissue
5. Decreases muscle tone via spindle cells and golgi tendon receptors
6. may break adhesions

Question 7

ROULOMONT (aka skin rolling)

Answer 7

1. lifts the skin away from the fascia surfaces underneath
2. similar to petrissage but you are only pulling the skin
3. Warms and softens superficial fascia

Question 8

Tapotement can be done with finger tips, tools, palms etc.

Answer 8

1. tapping or vibration applied rapidly to the soft tissue… hand in knife position and perform the chop chop
   i.e. in movies
2. Applied perpendicular to the muscle fibres, 8-10 sinusoidal vibrations per second
3. Produces reflexive physiologic effects in 2-5 mins
4. Hyperaemia, improved muscle tonicity (the state of tension or contraction in muscles when they are at rest. “Improved muscle tonicity” suggests that the stimulus leads to a positive change in the resting tension of muscles, possibly resulting in enhanced muscle function or readiness),reflex stimulation of cutaneous receptors (Cutaneous receptors are sensory receptors located in the skin that respond to stimuli such as touch, pressure, temperature, and pain. “Reflex stimulation” indicates that the stimulus triggers a quick, automatic response in these receptors, leading to sensory feedback or reactions)

Question 9

Benefits of Transvere Friction

Answer 9

1. side to side or small circular movements
2. moves skin over subcutaneous tissues and muscle
3. Lubricant is usually avoided because you are trying to move the tissue under the skin
4. Performed over ligaments or myofascial lesions
5. Stretches/releases adhesions
6. Reduces edema
7. Reduces fibrosis
8. Disperses pathologic deposits
9. Reduces pain
10. Reduces muscle spasms

Question 10

Benefits of Transverse Friction

Answer 10

1. vigorous friction applied across the
   treated tissue
2. breaks up adhesions, encourages absorption of exudates
3. Creates a controlled inflammatory response, causes heat and redness through histamine release and increased circulation*need to consider pt tolerance as it’s not
   overly comfortable

Question 11

Risk Factors of Mobilization

Answer 11

1. Exacerbation of symptoms with overuse
2. Muscle soreness or fatigue from introducing new movement
3. Joint instability for people with pre-existing joint issues

Rationale:
This involves gradually increasing the intensity of movement or exercise. The rationale behind the risks associated with graded mobilization includes the exacerbation of symptoms with overuse, such as increased pain or discomfort due to pushing the body beyond its current capacity. Muscle soreness or fatigue can also occur when introducing new movements, especially if the muscles are not accustomed to the specific actions.

Question 12

Risk Factors of Stretching

Answer 12

1. Delayed onset muscle soreness
2. Muscle or tendon injury – can cause strain
3. Joint instability for people with pre-existing joint issues
4. Overstretching or strain

Rationale: Stretching aims to improve flexibility and range of motion but can lead to delayed onset muscle soreness (DOMS) due to microscopic damage to muscle fibers. Overstretching or straining during stretching exercises can also cause muscle or tendon injuries, particularly if done improperly or too aggressively. People with pre-existing joint issues may experience joint instability or exacerbation of symptoms with stretching.

Question 13

Risk Factors of Traction/Distraction

Answer 13

1. Joint hypermobility or laxity with overuse
2. Potential muscle strain
3. Exacerbation of symptoms with overuse

Rationale: This technique involves gently pulling or separating joint surfaces to relieve pressure and improve mobility. However, overuse can lead to joint hypermobility or laxity, potentially causing joint strain. Muscle strains may also occur, especially if traction is applied too forcefully.

Question 14

Risk of Strain-counterstrain

Answer 14

1. Exacerbation of symptoms with overuse
2. Temporary soreness or discomfort

Rationale: This technique aims to reduce muscle spasms and pain by positioning the body in a relaxed state. However, overuse can lead to exacerbation of symptoms, such as increased pain or discomfort. Temporary soreness or discomfort may also occur after the procedure.

Question 15

Risk of Myofascial Release

Answer 15

1. Bruising or skin irritation due to pressure
2. Temporary increases in pain
3. Soreness

Rationale: Myofascial release techniques target the fascia (connective tissue) to improve mobility and reduce pain. Risks include bruising or skin irritation from pressure, temporary increases in pain, and exacerbation of symptoms, particularly if the techniques are applied too aggressively.

Question 16

Active Myofascial Release

Answer 16

1. Bruising or skin irritation
2. Temporary increase in pain
3. Exacerbation of symptoms
4. Soreness

Rationale: PNF techniques involve stretching and contracting muscles to improve flexibility and strength. Risks include muscle soreness, joint strain for individuals with hypermobile joints, pain from inappropriate nerve compression, and increased fatigue for those actively training.

Question 17

Risk of PNF Proprioceptive Neuromuscular Facilitation

Answer 17

1. Muscle soreness
2. Joint strain for people with hypermobile joints
3. Pain for inappropriate nerve compression
4. Can increase fatigue for people actively training

Rationale: This technique targets specific points of muscle tension (trigger points) to reduce pain and improve mobility. Risks include soreness, discomfort, bruising, skin irritation from pressure, and increased local pain if the pressure is too intense.

How to perform PNF:
Basic Types of PNF Stretching
Hold-Relax (most common)
Contract-Relax
Hold-Relax with Agonist Contraction
We’ll focus on the Hold-Relax method first as it’s widely used and easiest to apply.

Steps to Perform Hold-Relax PNF Stretching
Position the Muscle for Stretching (Passive Stretch)

Place the muscle in a comfortable end-range passive stretch.

To keep it simple use the numbers 6, 12, 30. Stretch for 6 seconds, isometric contract for 12 seconds, and stretch again for 30 seconds.
For example: To stretch the hamstrings, have the person lie on their back while you raise their leg to stretch the hamstring.

Duration: Hold for 6-10 seconds to let the muscle adapt to the initial stretch.

Isometric Contraction (Hold Phase)

Instruct the individual to contract the target muscle without moving.

Apply resistance against the contraction to prevent movement.

For example: Tell the person to push their leg down (into your resistance) without changing the leg position.

Intensity: ~75-100% effort (depending on experience and safety).

Duration: Hold the contraction for 6-12 seconds.

Relax and Stretch Further (Deeper Passive Stretch)

After the contraction, have the individual relax completely.

Immediately apply a deeper passive stretch to move the muscle into a new range of motion.

This phase takes advantage of the Golgi Tendon Organs (GTOs) that allow the muscle to relax further.

Duration: Hold the final stretch for 20-30 seconds.

Example: PNF Stretch for Hamstrings
Starting Position: Person lies on their back.
Stretch: You passively lift their leg into a hamstring stretch for 6-10 seconds.
Contraction: Ask the person to press their leg down into your resistance for 6-12 seconds without moving.
Relax and Stretch Deeper: Once relaxed, lift their leg into a new range and hold for 20-30 seconds.
Contract-Relax Variation
Difference: Instead of isometric contraction, the muscle contracts through a range of motion.
For example: The hamstring would press down actively into your resistance, moving the leg a little before relaxing.
Key Tips for Performing PNF:
Always communicate with the client/patient for comfort and feedback.
Gradually increase the range of motion to avoid overstretching.
Perform 2-4 repetitions of the PNF sequence for optimal results.
Avoid PNF stretching on injured or unstable joints.
Ensure a warm-up has been performed before starting PNF techniques.

Question 18

What are the Risk of Ischemic Compression

Answer 18

1. Soreness and discomfort
2. Bruising or skin irritation from pressure
3. Risk of injury from over-compression

Rationale: Ischemic compression involves applying pressure to reduce blood flow temporarily. Risks include soreness, discomfort, bruising, and skin irritation from pressure, as well as a risk of injury from over-compression.

Question 19

Risk of Effluerage

Answer 19

1. Allergic reaction to oils and lotions
2. Skin irritation from prolonged application of massage techniques
3. Risk of overstimulation in sensitive people, discomfort, nervousness and anxiety symptom

Rationale: Effleurage may cause allergic reactions or skin irritation from oils and lotions.

Question 20

Risk of Petrissage

Answer 20

1. Temporary muscle soreness
2. Temporary pain from breaking up adhesions
3. Bruising or skin irritation from aggressive or excessive manipulation
4. Risk of increased pain

Not appropriate for acute injuries
Rationale: Petrissage can lead to temporary muscle soreness, pain from breaking up adhesions, bruising, or skin irritation from aggressive manipulation.

Question 21

Risk of Roulomont

Answer 21

1. Bruising or skin irritation from aggressive or excessive manipulation
2. Not directly effective for muscular pain

Rationale: Roulomont may cause bruising or skin irritation from excessive manipulation and may not directly address muscular pain.

Question 22

Risk of Tapotement

Answer 22

1. Risk of temporary increased pain
2. Skin irritation and bruising
3. Not appropriate for acute injuries like fractures or on bony structures

Rationale: Tapotement can temporarily increase pain, cause skin irritation, and is not suitable for acute injuries or bony structures.

Question 23

Risk of Friction

Answer 23

1. Increased pain in connective tissue
2. Skin irritation
3. Not suitable for muscle belly pain/muscular knots
4. Controlled inflammation that may be irritating

Rationale: Friction can increase pain in connective tissue, cause skin irritation, and is not suitable for muscle belly pain or muscular knots.

Question 24

Benefits of trigger point release

Answer 24

How to perform:
it’s generally recommended to hold pressure on a single trigger point for about 30 to 120 seconds during each press. If the point remains tender, you may release the pressure briefly and then repeat if necessary

Benefits of trigger point release:
1. Pain Relief: Trigger points often refer pain to other areas, causing discomfort and muscle tension. Releasing trigger points can alleviate this referred pain and reduce muscle tightness.
2. Increased Range of Motion: Tight muscles with active trigger points can restrict joint movement. By releasing the points, muscle length can improve, allowing for a greater range of motion and flexibility.
3. Improved Circulation: Sustained pressure on a trigger point helps increase blood flow to the area after release. This helps bring oxygen and nutrients to the muscle tissue, which aids in healing and recovery.
4. Reduced Muscle Spasms: Trigger points can cause muscles to contract involuntarily or spasm. Releasing these points helps relax the muscle fibers, which can reduce or stop the spasms.
5. Enhanced Muscle Function: Trigger points can weaken the muscle and decrease its endurance. By treating these points, muscle function can improve, making it easier to perform daily activities or physical exercise.
6. Decreased Stress and Anxiety: Chronic pain from trigger points can contribute to stress and anxiety. Reducing this pain can improve mood and decrease stress, especially for people who experience pain daily.
7. Better Posture: Tight and painful muscles can cause postural imbalances, leading to poor alignment and additional strain on other muscles. Releasing trigger points helps improve muscle balance and supports better posture.
8. Support for Injury Recovery: Trigger point release can help with rehabilitation by reducing pain and muscle tightness in injured areas, allowing for more effective stretching and strengthening exercises as part of the recovery process.
9. Headache and Migraine Relief: Many headaches and migraines are related to tension in the neck, shoulder, and upper back muscles. Releasing trigger points in these areas can alleviate tension headaches and even some types of migraines.
10. Enhanced Athletic Performance: By reducing muscle tightness and improving range of motion, trigger point release can aid athletes in performing better with less discomfort and a reduced risk of injury.

Why not to hold it longer than 2 mins at a time isn’t recommended:
1. Risk of Tissue Damage: Prolonged pressure can reduce blood flow to the area, potentially damaging muscle fibers or surrounding tissue.
2. Nervous System Response: Holding pressure for too long can overstimulate nerve endings, causing discomfort or even increasing muscle guarding (a reflexive tensing), which makes the muscle tighten up rather than relax.
3. Circulation and Oxygen Supply: Trigger points often form due to muscle tension that restricts blood flow. Short bursts of sustained pressure can help release tension, improve blood flow, and encourage oxygenation in the muscle. Prolonged pressure, however, might restrict blood flow too much, which can be counterproductive.
4. Pain Tolerance and Patient Comfort: Holding pressure for too long can be very uncomfortable for the patient, which can make the therapy session less effective or even discourage further treatment.
5. Diminishing Returns: After about 120 seconds, most of the potential therapeutic effect of trigger point release is achieved, so additional time usually doesn’t provide extra benefit.

By limiting the pressure hold to around 30-120 seconds, practitioners can effectively release trigger points while minimizing discomfort and risk to the muscle tissue.

Question 25

Is cross fiber friction and friction rub the same thing but when applying on different areas is why it's name change as in the muscle its cross fiber friction but over the tendon its the same technique but will be called friction rub?

Answer 25

**YES** **1. Cross-Fiber Friction:** Technique: Cross-fiber friction is a type of deep tissue massage technique where the therapist applies pressure perpendicular (across) to the direction of the muscle fibers, tendon fibers, or ligament fibers. Application: This technique is mainly used on muscles and ligaments, especially to break down adhesions, reduce scar tissue, and promote healing in injured soft tissues. Focus: It's specifically applied to muscles, ligaments, or tendons that have become fibrotic or have scar tissue, helping to release adhesions and improve mobility. **2. Friction Rub:** Technique: Friction rub is essentially the same as cross-fiber friction but is often used when treating tendons or other tissues like ligaments that are subjected to repetitive trauma. The technique involves applying forceful pressure in a back-and-forth motion, often perpendicular to the tendon fibers. Application: This term is used when the focus is on tendons or joint areas, like the supraspinatus tendon, Achilles tendon, or other tendons that have developed adhesions, inflammation, or calcifications. It’s especially effective for tendon injuries (e.g., tendinitis, tendinosis). Focus: It’s applied to tendons to promote tissue repair, reduce inflammation, and help in breaking down scar tissue or calcium deposits. Summary: Cross-fiber friction is often used when working on muscles and ligaments (for muscle injuries or scar tissue). Friction rub is the same technique but used primarily for tendons to address issues like tendinopathy or calcification. Key Difference in Naming: The technique itself is similar—both involve friction applied across the fibers, but the term "friction rub" is often used when treating tendons, while "cross-fiber friction" is more commonly used for muscles and ligaments. Location: The technique may be referred to as cross-fiber friction when applied to muscles, but when used on tendons, it might be referred to as friction rub. The technique does not change, just the area of application.