Massage and Soft Tissue Mobilization

what is a general recreational massage

use of a variety of manual techniques designed to relieve stress, promote relaxation and general wellness in a person who has no definable heal problem

what is soft tissue mobilization

the application of specific soft tissue manipulation to restore tissue and joint mobility, and to restore normal function in the neuromuscular system

what is therapeutic massage

the intentional and systematic manipulation of the soft tissues of the body to enhance health and healing

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

why is fascia so important when it comes to massage and soft tissue mobs

it covers every organ, muscle, tissue and separates tissue and provides structural support while also acting as a force generator

what is thixotropy

heat generated through movement improves mobility of fascia

what is a really good existential crisis that Schubbe gave us

are there really 600 muscles or only 1 muscle in 600 fascial pockets

why dont we want to be local when it comes to our soft tissue mobs

because of the myofascial meridians that basically connects everything. there could be some funky referral patterns

what are the integument effects of massage

enhance tissue repair and scar formation

improve connection tissue health

what are the MSK effects of massage

move metabolic waste to lymph system

muscle relaxation, reduce TrPs or eliminate myofascial adhesions

promote improved joint mobility and flexibility

what are the nervous system effects of massage

stimulate PNS and SNS

stimulate a-beta sensory nerves, reduce pain response

what are the endocrine effects of massage

elevate modd

promote relaxation

reduce stress response

what are the CV and pulm effects of massage

increase circulation and venous return, reduce BP/HR

promote diaphragmatic breathing, rib cage expansion

promote lung secretion/ excretion

what are the digestive/ urinary/ repro effects of massage

improve digestion, facilitate bowl movement, increase urinary output, improve reproductive function

what are the lymph effects of massage

improved lymph movement

improved immune function

what are the psychological effects of massage

pain relief/ reduction

increased mental clarity

reduced anxiety/ depression/ tension

promote generate feeling of well being

promote feeling of connectedness

somatoemotional release

sexual arousal via limbic system influence

what are the indications for massage

decrease edema

decrease muscle spasm and pain

increases soft tissue mobility and joint range of motion

improve relaxation

improve lung secretions/ drainage for specific respiratory conditions

what are the precautions to massage

compromised immunity

circulatory compromise (varicose veins and severe arteriosclerosis)

gross or severe edema

decreased sensation

low blood pressure

sensory defensiveness

endangerment areas

what do we need to know about edema before we proceed with the massage

the source of it

why do we want to be careful with patients with LBP and massage

because if we stimulate their PNS, it could lower their BP even more and cause them to pass out

why do we want to be careful with patients with compromised immunity

we dont want to push the crush around their body

what are endangerment areas

areas of the body where delicate structures are less protected and more susceptible to injury during massage

what are examples of endangerment areas

anterior triangle

posterior triangle

face

axilla

medial and lateral epicondyle

sternal notch

umbilicus

dorsal 12th rib

sciatic notch

inguinal triangle

popliteal fossa

what do you do if you feel a pulse

youre over a major blood vessel

move away

what do you do if a patient reports burning, searing, pins and needles or numbness

youre on a nerve so move away

what are some absolute contraindications to massage

patient is in severe distress

acute inflammation/ trauma

known or suspected pathology that might spread through skin lymph blood

what are some relative contraindications to massage

recent surgery, around burns, recent fracture, open wounds

decreased sensation

increased sensitivity to touch

osteoporosis

HTN

what do you avoid with a patient who has hypertension

abdominal massages because of the valsalva manuver and blood pressure increases as you relax and returns centrally

what are the types of professional boundaries/ standards

physical

emotional

intellectual

sexual

energetic

what are the majority of complaints that come from patients in regards to violation of boundaries

blurring professional and social roles (patients dont make good friends and friends dont make good patients)

therapists going beyond the borders of the expertise

how do you avoid issues related to ethics in massage

adequate explanation is essential

if you detect reluctance/ reservations then dont proceed, do something else

high level of ethical practice to ensure modesty

what does effective massage require

therapist preparation

patient preparation

equipment

correct application techniques

what falls under dosing for massage

direction

pressure

rate/rhythm

duration

frequency

strokes

how do we present ourselves physically to our patients when we prepare for massage

maintain high standards of physical appearance and hygiene

remove jewelry, keep hands and nails well kept

keep hands warm and dry

how should our hands be when we massage

kept loose and relaxed, wrist in neutral position

protect your thumbs

how should our body be when we massage

use elbows, forearms for covering larger areas/ increased pressure

tai chi stances

use your whole body

what is centripedal direction

towards the heart

what is centripedal direction good for

venous issues and known edema

what is centrifugal direction

away from the heart

what is centrifugal direction good for

arterial insufficiency

what does light pressure help activate

the PNS

what does deep pressure help activate

the SNS

what is rate

speed of massage movements

6-7 inches per second

what is rhythm

the cadence and recurrence of a pattern of movement

what is duration

time spent altogether as well as time spent in a single area

varies based on goals

how often can you get a massage

daily if indicated

what is effleurage good for

assessing tissue health and quality

promotes venous return and lymph movement

what is effleurage

sliding over the skin in long smooth strokes

used to start of finish a massage or as a transition between different other strokes or areas

what is petrissage

involves lifting, wringing, or squeezing the tissues with minimal sliding

what is the purpose of petrissage

stimulate deeper circulation, assist with venous return

milk metabolic wastes from muscles and tissues

promote muscle relaxation

what are the types of petrissage

kneading

picking up

wringing

skin rolling

finger to thumb

circle two handed

what is tapotement

percussive tissue manipulation following in rapid alternating succession

light rhythmic and rapid

tends to be used as a finishing technique

what is tapotement good for

respiratory therapy

increases circulation

what are the types of tapotement

clapping/ cupping

tapping

hacking

beating

pounding

what is a friction massage

different type of stroke and purpose- 3 dimensional technique

designed to affect connective tissues, break up fibrous adhesions, and stimulate an inflammatory healing response

what are the types of friction massage

superficial warming

deep friction

cyriax friction

what is superficial warming used for

use of palm briskly rubbed over skin to generate heat

what is deep friction used for

to reduce tissue adherence

what is cyriax friction good for

deep transverse friction applied directly over lesion

what is vibration/ shaking

oscillating, quivering or trembling movement back and forth or up and down performed quickly and repeatedly

movement applied through entire arm

what is the purpose of vibration/ shaking

mobilize section

reduce muscle tension

improve GI motility

improve circulation

what are the myofasical massage guidelines

locate restriction

use little to no lubricant

choose a technique based on the depth

gentle contact with skin and apply pressure until you feel restriction

shift tissues horizontally and avoid compressing bone

how long do you have to hold myofascial releases

at least 2 minutes

2-5 minutes

what is fascial stretch

elongation of fascial tissue in broad areas

tension help 2-5 minutes

includes cross hand stretch and pin and stretch

what is fascial mobilization

shearing forces release bonds

applied pressure down into tissues then shift horizontally

use palm forearm and fingers to apply pressure and shift based on tissue depth and surface area

what is skin lifting

frees restrictions in subcutaneous fascia

picking up, picking up and directional shift, skin rolling

what is the theory behind myofascial decompression

cellular aging, immobility and trauma reduces delivery of nutrients and oxygen, interrupts removal of cellular wastes

what is the effect of the negative pressure of vacuum therapy

steril inflammation

auto-hemotherapy

destruction of adhesions

capillary regeneration

microcirculation restoration

increased local metabolism and lymph flow

what are the contraindications of myofascial massage

avoid in presence of local tissue damage

avoid immediate areas surrounding joints with arthritis, inflammation and gout

generally avoid in patients with acute cellulitis, fever or systemic infections, lymphedema, advanced osteoporosis or diabetes, steroid or anticoagulant therapy

what is a trigger point

nodules or bands in tissues and tendons that are painful with palpation and create radiating pain in a specific pattern

what are trigger points caused by

repetitive stress

poor posture

what do trigger points cause

motor, sensory and autonomic phenomena

what is latent TrP

painful only when pressed

what is active TrP

always tender weakens and shortens muscle, refers pain

what is primary TrP

activated by acute or chronic muscle overload

what is associated TrP

activated by primary TrP or by being in the referral zone of primary TrP

how do you deactivate a trigger point

direct pressure techniques

ischemic compression applied with thumb, finger or pincer technique

how much pressure do you provide to a patient with a trigger point

enough to engage the tissue without causing extreme pain

increase the pressure as the sensitivity reduces

release when tension subsides

what are the contraindications of trigger point therapy

undiagnosed conditions that are causing severe pain

painful areas related to acute trauma

locally over bruises, wounds, or other soft tissue damage

any contraindications for massage

what are the indications for instrument assisted massage

pro inflammatory response creating microtruama for inflammatory cascade

facilitatory- biofeedback enhances movement patterns and ROM

edema reduction

pain reduction

scar mobilization

cyriax friction

fascial mobilization

why do PTs like instrument assisted massage

it protects our joints so we can keep paying off our student loans

what are the contraindications for IASTM

open wounds and unhealed suture sites

thrombophlebitis

uncontrolled HTN

inflammation from infection

unstable fracture

contagious or infections skin conditions

hematoma/ myositis ossificans

osteomyelitis

what are the precautions or relative contraindications for IASTM

cancer

burn scar

kidney dysfunction

anticoagulant therapy

varicose veins

RSD/ CRPS

DM

autoimmune: RA

lymphedema

what is the IASTM mechanism of action

increased fibroblastic activity

promotes mechanotransduction

piezoelectric phenomenon

what is the piezoelectric phenomenon

skin has a negative charge so we are stimulating that to promote healing

why would we choose concave edges

increase contact with the skin= more comfy

why would we choose convex edges

reduced contact surface area= more intense

why would we choose a single bevel edge

more intense

why would we choose a double bevel edge

less intense

why would we choose a large instrument

a larger surface area

why would we choose a small instrument

specialized shapes and contours