 Dating back to the ancient Olympians

 Late 1980’s
◦ American Massage Therapy
 1992
◦ National Certification Examination for Therapeutic
Massage and Bodywork
 Manipulates the the body’s tissues to:
◦ Reduce muscle spasm
◦ Promote relaxation
◦ Improve blood flow
◦ Increase venous drainage
 Broad range of massage theories,
techniques, and effects
◦ On Pain
 Gate control theory
 Endogenous Opiates release
◦ On Circulation
 Somatosympathetic reflex - probably does not occur
with massage, since massage is passive.
 Axonal reflex occurs when cutaneous afferent
information travels antidromically and produces a local
vasodilation
◦ On Metabolism
 Does not alter metabolism significantly
◦ On Motor Neuron Activity
 There is an inhibition of the spinal motor neuron
excitability during a massage. It is specific to that
muscle with no lingering effects
◦ stretching and mobilizing tissues
◦ mechanically increase blood flow and venous return
of that muscle
 Light exercise is more effective in increasing
blood flow than massage
 Cellular metabolism
 Increase ROM short-term, but no Long-term
effects
 Massage appears to have no benefit on
recovery of muscle function in the following
situations:
◦ muscle damage caused by eccentric overload.
◦ recovery of post-exercise muscle strength.
◦ reduction of delayed onset muscle soreness (DOMS).
◦ rate of recovery of muscle function following
anaerobic work.
 You communicate compassion, concern,
anger, sensual, or other emotions through
touch.
 Basic Strokes:  Myofascial Release:
 Effleurage  J-Strokes
 Pétrissage  Focused Stretching
 Friction  Skin Rolling
 Tapotement  Arm Pull / Leg Pull
 Vibration  Diagonal Release
 Effleurage (stroking)
◦ Superficial or Deep
 Petrissage (kneading)
 Friction
◦ Transverse or Longitudinal
 Vibration
 Tapotement
◦ Percussion/slapping/hacking/beating
 “Stroking of the skin”
 Spread massage lubricant
 Use at the beginning and end of the massage
 Superficial:
◦ slow strokes for relaxation
 Deep:
◦ Elongates muscle fibers
◦ Stretches fascia
◦ Forces fluids in the direction of the stroke
 towards the heart
 “Lifting and kneading”
 Frees adhesions:
◦ Stretches and separates muscle fiber, fascia, and
scar tissue
 If only technique used, it may be performed
without the use of lubricant
 “Deep pressure”
 Circular:
◦ Use a circular motion with thumbs, elbow, or a
commercial device
 Transverse Friction:
◦ The thumbs or fingertips stroke in opposite
directions
 Effects muscle mobilization, tissue
separation, and trigger points
 “Tapping or pounding” of the skin
 Variations:
◦ Hacking
◦ Cupping
◦ Pincement (pinching)
◦ Rapping
◦ Tapping
 Performed with a light, fast tempo
 Promotes muscular and systemic
relaxation and desensitization of irritated
nerve endings
 “Rapid Shaking”
 Rolling a limb between hands (arm/leg)
 Increases blood flow and provides systemic
invigoration of tissues
 Mechanical devices available
 Stroking and stretching of tissues:
◦ Relax tense tissues
◦ Release adhered tissues
◦ Restore tissue mobility
 Clinician receives cues and feedback from
the patient’s tissue
◦ This indicates the appropriate strokes and
stretches
 Specialized training in myofascial release
techniques is needed to become proficient
in these skills
 One hand places the adhesion on stretch
 Other hand’s 2nd and 3rd fingers stroke in
the opposite direction forming a ‘J’
 Mobilize scar tissue
 Heel of one hand in the area of restriction
 Heel of other hand crossed in front
 Stretch the tissue using slow, deep pressure
 Reduces superficial or deep adhesions
 Use fingers and thumb to lift and separate
the skin from the underlying tissue
◦ Similar to Pétrissage
 Roll skin between fingers noting restriction
 Lift skin and move it in the direction of the
restriction
 Reduces superficial myofascial adhesions
 Arm pull (example):
 Grasp extremity proximal to wrist
 Apply gentle traction that is in line with
anterior deltoid
 Continue to abduct 10-15 degrees until full
abduction is reached
 Stretches large areas of fascia
 Cardiovascular
◦ Increase blood flow, histamine release, and temperature
◦ Decreased heart rate, respiratory rate, and blood pressure
 Neuromuscular
◦ Increase flexibility, decrease neuromuscular excitability
(relaxation), edema reduction, and stretch muscle and
scar tissue
 Pain
◦ Activate spinal gate and the release of endogenous
opiates
 Psychological
◦ Reduces patient anxiety, depression, and mental stress
 Increase blood flow
 Facilitate healing
 Increase range of motion
 Remove edema
 Alleviate muscle cramps
 Stretch scar tissue/adhesions
 Decrease pain
 Acute inflammatory conditions
 Severe varicose veins
 Open wounds
 Skin infections
 Failed or incomplete fracture healing
 Thrombophlebitis
 Table
 Linens and pillows
 Massage lubricant
 Patient position
 Masseuse position
 Apply massage medium with light, slow
 Build to deeper effleurage
 Pétrissage
 Wipe medium before applying deep friction
(if applicable)
 Reapply pétrissage and deep effleurage
 End with light effleurage
 Elevate the body area
 Apply massage lubricant to the skin
 Clinician is positioned distal to the
extremity
 Begin proximal to the edematous area
 Long, slow, deep strokes towards the torso
 Move starting point slightly distal every
fourth or fifth stroke
 When the starting point moves distal to the
edema, begin working back towards the
starting point
 Remove medium
 If appropriate:
◦ Active range of motion exercises
◦ Compression wrap
 Encourage patient to drink water to assist in
flushing metabolic waste
 Soft Tissue Healing
◦ Injury
 Protect
◦ Inflammatory Phase
 Effleurage (Lymphatic) massage
 Light petrissage
 Avoid friction massage
 ◦ Fibroblastic-Repair Phase
 Effleurage and petrissage to reduce edema
 Friction to help tension the collagen for proper
alignment, thus preventing adhesions.
◦ Maturation-Remodeling Phase
 Patient education
 Pain Cycle
 Inflammation

Physical Trauma
Dysfunction Pain
Psychological Trauma

ischaemia

Muscle Spasm
 Chronic Injury
◦ Friction
◦ Petrissage
◦ Effleurage (lymphatic)
(Fritz, 1995)
(Fritz, 1995)
 Indications
◦ Patients with adhesions, edema, muscle spasm,
bursitis, tendinitis, tenosynovitis, strains, and
sprains.
 Contraindications
◦ Patients with myositis ossificans, thrombosis or
embolism, severe varicose veins (caution), acute
phlebitis, cellulitis, synovitis, abscesses, shin
injections, and massage of a cancerous site.