1
Q
Influencing Soft Tissue
A
Reduce tension/tightness
- Improve ROM
- Reduce pain
Stimulate low tone muscle
- Facilitate motor firing
- Improve motor control
Assist in healing
- Move O2 and nutrients to the area of inflammation
- Move cellular debris out of the area of inflammation
- Edema reduction
- “laying down new collagen fibers”
2
Q
Effects of Soft Tissue Manipulation
A
Primary Effects:
- Mechanical
- Physiological
- Psychological
3
Q
Mechanical Effects
A
Movement of:
- Blood
- Lymph
- Lung Secretions
- Chronic Edema
- Intestinal Contents
Mobilization of:
- Muscle Fibers
- Tendons
- Tendon Sheaths
- Ligaments
- Joint Capsule
- Skin and subcutaneous -tissue
- Fascia
- Scar tissue/Adhesions
4
Q
Physiological Effects
A
Increased blood and lymph flow
Increased flow of nutrients
Removal of waste products and metabolites
Stimulation of the healing process
Resolution of chronic edema and hematomas
Pain relief
Increased extensibility of connective tissue
Increased joint movement
Facilitation of muscle activity
Stimulation of autonomic functions
Stimulation of visceral functions
Promotion of local and general relaxation
5
Q
Psychological Effects
A
Physical relaxation Relief of anxiety and tension (stress) Reduce fear Stimulation of physical activity Pain relief General feeling of well-being (wellness) Sexual arousal General faith in the laying on of hands
6
Q
Therapeutic Massage
A
the use of a variety of manual techniques designed to promote stress relief and relaxation, mobilize various structures, relieve pain and swelling, prevent deformity and promote functional independence in a person who has a specific health problem
7
Q
Recreational Massage
A
use of a variety of manual techniques designed to relieve stress, promote relaxation and general wellness in a person who has no definable health problem
8
Q
Hand Preparation
A
Nails: reasonable short, well rounded
Washed
Warm
Express gentleness, firmness, strength
9
Q
Mediums
A
- Always best to start with less
- Be careful of cross-contamination
10
Q
Medium: Powder
A
allows deep work without any slipping on the skin
Ex) Chalk, Starch, boracic,
Baby powder
-Avoid heavily scented powders
Caution: powder gets on everything, may cause a fall, inhaling
11
Q
Medium: Cream
A
tend to be absorbed by the skin
Ex) Lanolin, Nivea, Cocoa butter, Bee’s wax
-Caution: allergies and too much cream prevents firm grasp
12
Q
Medium: Oil
A
skin and subcutaneous tissues
Ex) Baby oil, mineral oil, Vitamin E, Olive oil
-Caution: deep strokes are harder and can run into clothing
13
Q
Medium: Soap and Water
A
- Effective if the skin is scaly, dry or dirty
- Use enough soap to create some soapsuds
- Medicated or antibacterial soap is best
- Stroking most useful technique
14
Q
Positioning and Draping
A
Position
- Comfortable for the patient as well as ease of access for the therapist
- Remember your own body mechanics
Support
-Pillows, bolsters, towel rolls
Warmth
- any part not being massaged should be covered when possible
- Preserve modesty but at same time, body parts being massaged should be accessible and exposed
- Most versatile material is a clean, folded sheet NOT the patient’s own clothing
15
Q
Draping Position
A
- Back open drape
- Front open drape
- Side open drape
- LE drape
- UE and neck drape
16
Q
Essential Components of Good Technique
A
Comfortable support and positioning of patients
PT keeps hands flexible, relaxed and fit contour of body being massage
Correct rate of movement
Maintain an even rhythm
Regulate pressure according to type of stroke, type of tissue and purpose of treatment
Keep good body mechanics
17
Q
Components of Bad Technique
A
Patient sore for multiple days post massage
Bruising
Patient not able to relax
Bony landmark massages
18
Q
General Relaxation
A
state of the entire person
19
Q
Local relaxation
A
state of the body part being treated
20
Q
Factors that inhibit relaxation
A
Psychological factors
Strange or untidy surroundings
Odors, noise, cold
Inadequate support, draping, or positioning
21
Q
Directions of the Stroke
A
Centripetal: toward the heart
-In the direction of venous and lymphatic flow
Centrifugal: away from the heart
-In the direction of arterial flow
Related to anatomical structure
Right angles to the tissue = cross friction
22
Q
Pressure of the Stroke
A
Depends upon the purpose of the stroke and patient’s physical problems
Difficulty to evaluate accurately, but effect depends on the regulation of the pressure and the stimulation it produces
Varies based on patient
23
Q
Superficial Pressure
A
- produces mild stimulation, induces relaxation and diminishes pain
- Best to use at beginning and end of a massage or as a transition between some strokes
24
Q
Deep Pressure
A
-strong stimulation, increases tension and pain.
25
Rate and Rhythm of the Stroke
General rule: strokes should be slow, gentle and rhythmic
Slow strokes are relaxing, 6-7 inches per second in the larger areas
Faster strokes increase tension
Percussion strokes are required to be rapid
26
Duration and Frequency of massage
Therapeutic massage: 15-20 min
Lymphatic massage: 15 min or longer
Full-body massage: 45 min or longer
Cross friction massage: 10 – 12 min or longer
27
Classifications of Massage Strokes
-Stroking
-Petrissage
(Kneading, Pick-up, Wringing, Skin Rolling)
-Tapotement
(Hacking, clapping, beating, pounding)
- Vibration and Shaking
- Deep Friction
28
Stroking
-movement performed with the entire palmar surface of one or both hands moving in any direction on the surface of the body
29
Purpose of Stroking
Begin and/or finish a massage sequence
Applying medium
Helps patient relax and become accustomed to therapist’s hands
```
Slow = promotes relaxation
Fast = stimulating
```
Provides information to the therapist about the patient’s tissues
Help relieve muscle spasm and indirectly pain
Also used for joining sequences of other strokes
30
Stroke Pattern
Movement can be in any direction
One direction at a time
Move along a line parallel to the long axis of the body or across the long axis
Can be diagonal
Continuous movement
Rhythmic movement
One or both hands
31
Effects of Stroking
Produced through direct mechanical input
Significant relaxation when performed slowly
(Sedative effect)
Stimulating effect on sensory nerve endings when performed quickly
(Invigorating effect)
Dilation of arterioles in the deeper tissues when applies slow/deep
32
Indications of Stroking
Help relieve or reduce the effects of:
```
Pain (acute or chronic)
Muscle Spasm (acute or chronic)
Superficial scar tissue (skin)
Flatulence, constipation or abdominal discomfort
Move with the direction of the bowel
Right, up, over, down on left
Insomnia
```
33
Contraindications to Stroking
Large open areas (burns, wounds) - Always
Gross edema (danger of splitting the skin with the strokes) - Always
Cancer, infections, lacerations - Always
Marked varicosities if damage to vein wall might occur - Usually
Precautions - Rare
Extremely hairy regions of the body
Hyperesthisia (sensitive / ticklish)
34
Effleurage
Slow, stroking movement performed with increasing pressure in the direction of flow in the veins and lymph vessels
Centripetal movements
Has a definite pause
35
Purpose of Effleurage
Move contents of superficial veins and lymph vessels
Facilitating circulation
Used between manipulations to mobilize tissue fluids
Finish off a massage sequence
36
Basic Technique and Direction of Effleurage
Direction of venous and lymphatic flow atarting with fingertip then palmar surface of hand
Stroke is directed toward the lymph glands
Distal to proximal
Hands return to starting position for next stroke
Ex) Arm and Back = go towards axilla
Knee = go towards posterior
37
Rate and Depth of Effleurage
Rate:
- Slow
- 6-7 inches per second
- Even rhythm
Depth
- Pressure gradually increases
- Blood and lymph pushed through veins and lymph channels
- Pause at end of each stroke, allows valves in vessels to close
38
Effects of Effleurage
Blood flow moved toward heart
Lymph flow moved toward glands to accelerate healing
Congestion in capillaries is relieved which stimulates circulation and facilitates healing
Increase mobility of skin and superficial tissues
Dilation of superficial arterioles – axon reflex
Relief of pain by stimulation of large-diameter mechanoreceptors
39
Therapeutic Use of Effleurage
Accustom patient and therapist to the intervention
Follow up the deeper strokes (friction, kneading) and enhance absorption of waste products
Sub acute and chronic stages of inflammation to promote absorption of inflammation byproducts
Relieve pain and promote relaxation
40
Indications of Effleurage
```
Chronic edema
(Especially in extremities)
Chronic pain
Chronic muscle spasm
Superficial scar tissue
```
41
Contraindications of Effleurage
Same for stroking
Add:
Chronic swelling in the lower limb associated with congestive heart failure – Usually
Other heart conditions in which lower limb edema occurs - Usually
42
Petrissage
Pressure or kneading massage
Firm pressure applied to tissues
Mobilize deep muscle tissue or skin and subcutaneous tissues
```
Four types of strokes
Kneading
Picking up
Wringing
Skin rolling
```
43
Petrissage: Kneading
Alternately compress and release muscles and tissue
Circular motion
Purpose:
- Mechanical action to affect deep tissue
- Mobilize muscle fibers to lengthen and glide over other muscles
- Promote normal function
44
Kneading Basic Technique
Direction of movement is circular, constant pressure (light to heavy)
Movement of hands occurs during relaxation phase
Can use several parts of one or both hands, fingers, or thumb
2 phases:
-Pressure phase the hand and the skin move together on the deeper structures
-Release phase they glide smoothly to an adjacent area
Then repeat!
45
Kneading Rate and Depth
Rate:
- Slow
- 3-4 seconds to complete a movement
- Lower rate if finger/thumb pads
- Duration: 20 – 60 seconds
Depth:
- Significant pressure on tissues
- Varies based on structures you are working on
- Not harmful pressure
46
Kneading Technique
Compression kneading: palmar kneading, classic stroke, entire palmar surface of the hand
A: pressure applied during ½ the circle and relaxation the other half
B: progression of hand movement along the trunk
C: progression of hand movement along the leg, either side of limb
47
Other Types of Kneading
```
Squeeze kneading
Finger pad kneading
Thumb pad kneading
Reinforced kneading
Knuckle kneading
```
Pressure: light to moderate
Direction: circular or elliptical
Rate: 0.5 – 2 seconds per cycle
Duration: 0 – 20 seconds duration
48
Squeeze Kneading
- Tissues pressed upward and lifted away from the underlying tissues, squeezed, then allowed to relax
- Lumbrical grip
- Usually performed on larger muscles
- Thumb and finger pads for smaller muscles
49
Finger Pad Kneading
- aka Digital Kneading
- Basic palmar kneading but performed with one or more finger pads.
- Can work in phase or out of phase down each side
- Best for small to medium areas of irregular shape
50
Thumb Pad Kneading
-Same as with finger pads
-Useful for fusiform muscles
(Wrist flexors or extensors
Anterior tibial muscles)
-Useful for small areas
Hand
Foot
Face
51
Reinforced Kneading
- Two-handed technique
- One hand reinforces the other
- Basic palmar kneading technique with one hand on top of the other
- Useful for lumbar region or larger patients
- Typically palm but can be performed with thumbs or finger pads
52
Knuckle Kneading
-Useful for small areas where greater depth of pressure is required
Sole of the foot
- Uses the dorsal surface of middle or proximal phalanges
- Closed fist
- Same circular motions
- Clockwise is easier
53
Petrissage: Picking Up
- Grasping and squeezes muscles while simultaneously lifting them away from the underlying tissues then releasing them
- Performed in a circular motion
- Same direction as the fibers (long axis)
- Purpose: Mobilizing individual or groups of muscles through a mechanical action on the fibers.
- Also facilitates normal joint and limb function
54
Picking Up Basic technique
- Single hand or double hand
- Tissue is picked up with whole hand with the thumb abducted
- Lumbrical grip
- Squeezed during first half, released during second half.
- Upward and inward in circular motion
55
Picking Up Rate and Depth
Rate:
- Slow, 1-3 seconds per cycle
- Duration: 20 – 60 seconds
- Continuous and rhythmic
- Whole muscle belly treated
Depth:
- Deep and hard pressure required to pick up tissue
- Not as deep as compression kneading
56
Petrissage: C-Kneading
- Variation of Picking-up
| - Muscle tissue is bent in to a “C”
57
Petrissage: Wringing
Tissues are lifted with both hands then compressed alternately between the fingers and thumb of opposite hands
Purpose: mobilizing individual muscles or groups of muscles
Increase muscle mobility due to “twisting” motion imparted on tissues resulting in significant mechanical action on the fibers
Facilitate normal joint and limb function
58
Wringing Basic Technique
```
Hands along the middle of the muscle with thumbs abducted
Tissues grasped with both hands
Lifted
Wrung out
Then relaxed
```
Movement is up and down the long axis of the muscle
59
Wringning Rate and Depth
Rate:
- Slow, 1-3 seconds per cycle of compression/release
- Duration: 20 – 60 seconds or more
- 4-6 inches per second
- Even rhythm
Depth:
- Deep stroke
- Sufficient pressure to lift muscle and compress it
- Do not pinch the tissue
60
Petrissage: Skin Rolling
Skin and subcutaneous tissue are rolled over deeper structures
Purpose:
- Mobilize skin and subcutaneous tissues
- Improve circulation in area
- Evaluate areas of discomfort (Osteopathic)
61
Skin Rolling Basic Technique
Hands side by side
Extended fingers draw skin towards the thumb lifting a fold of skin between fingers and thumbs
“Crawl” fingers along while thumbs trail lifting skin a long the way
Do not use a medium!
62
Skin Rolling Rate and Depth
Rate:
- Slow
- 4-6in per second
- do not pinch the tissues
Depth:
- Skin and subcutaneous tissues
- Cannot be done on all body parts
63
Primary Effects of Petrissage: Circulation
- Relieves congestion in small capillary beds
- Stimulates flow of lymphatic tissue
- Vasodilation in the skin
64
Primary Effects of Petrissage: Muscles
- Increases blood supply
- Decreases metabolic waste products
- Relaxes muscle and decreases pain
- Can improve scar tissue mobility
- Promotes normal joint and limb function
65
Effects of Petrissage: Skin and Subcutaneous tissue
- Increase blood supply
- Decrease inflammation
- Promotes elasticity
May see a reactive hyperemia with this stroke
66
Therapeutic Use of Petrissage
```
Facilitate deep and superficial circulation
Mobilize muscle contractures
Mobilize scar tissue
Help resolve chronic edema
Relieve muscle pain and fatigue
Promote relaxation
```
67
Contraindications of Petrissage
-Acute trauma – Always
(Use Effleurage)
- Muscles that are known to be torn - Always
- Skin diseases such as acute dermatitis, psoriasis or other infectious skin diseases - Usually
- Damage to blood vessels
- Hyper or hypotonic limbs - Usually
- Cancer in or near area being treated - Always
- Bacterial infections in or near area being treated - Always
68
How to start a massage?
1) Ask about allergies first!
2) Stroking
- Superficial to deep
3) Efflurage
- Supericial to deep
4) Petrisage
(Kneading, picking up, wringing, skin rolling)
5) Efflurage
6) Stroking
7) Tap!
