Massage treatment 2 FINAL OP

cross fiber frictions method

warm to muscle stripping, remove oil, lengthen to 1st barrier

communicate pain <7/10, should decrease

apply frictions perpendicular to tissue w/ reinforced thumb/fingers 2min or until decreased pain / softening

flush with Swedish

take up slack and stretch 15-30s

ice: consent (cold-burning-aching-numbness) - patch test (30s) - apply ice 5 min / until numbness - remove and let tissue rest

ice therapy method

explain CBAN - place barrier between ice and skin - apply patch test (5-10s) - apply ice for 5 min / until numbness, checking in at 30s then 2 min - remove ice and let tissue rest

ice therapy side effects

CBAN (cold-burning-aching-numbness), redness, temporary stiffness

ice therapy risks

ice burn; excessive redness; irritation

fascial work indications

adhesions in muscle, fascia, scar tissue

fascial work side effects

itching / burning, slight pain

fascial work risk

bruising

fascial work general method

warm + stretch tissue first (lever if possible) - apply technique until hyperemia, dec pain, softening / creep - follow with soothing / flushing

shearing indications

fascial restrictions, adhesions

what is hyperemia

increase in local blood flow that creates redness + warmth in tissue

purpose of joint mobilizations

improve joint play + arthrokinematics, reduce pain, increase ROM

joint mobilization indications

pain + muscle guarding, capsular restriction / dec joint play, adhesions / contracture limiting ROM

joint mobilization contraindications

hypermobility / instability, acute inflammation or joint effusion (for stretch), bone disease / fracture / malignancy

joint mobilization grade with pain BEFORE limitation

grade 1 (pain relief)

joint mobilization grade with pain AT limitation

grade 2 (gentle stretch)

joint mobilization grade with pain AFTER limitation

grade 3 / 4 (stretch capsule)

grade 1 joint play

small amplitude, slack remains, pain relief

grade 2 joint play

take up slack, pain relief + maintain joint play, assessment grade

grade 3 joint play

stretch capsule, increase ROM

grade 4 joint play

small amplitude at end range, increase ROM

grade 5 joint play

thrust, NOT in RMT scope

movement pattern for performing oscillations

oscillate into the glide/distraction - return to neutral, repeat rhythmically

large amplitude (grades 2-3) oscillations duration

2-3s per oscillation, 1-2 min total

small amplitude (grade 1 & 4) oscillations duration

rapid, vibration-like; 1-2 min total

oscillations purpose

reduce pain, maintain or increase joint play, improve arthrokinematics

how to perform oscillations

place joint in open packed position - stabilize proximal bone - oscillate into glide/distraction, then return to neutral - keep rhythm consistent

grade 2-3 oscillations timing

slow, 2-3s per oscillation, 1-2 min

grade 1 & 4 oscillation timing

small, fast (vibration like), 1-2 min

grade 1 oscillation amp, speed, purpose

small, fast, decrease pain

grade 2 oscillation amp, speed, purpose

large, slow, decrease pain + maintain play

grade 3 oscillation amp, speed, purpose

large, slow, increase ROM

grade 4 oscillation amp, speed, purpose

small, fast, increase ROM

gr 1 sustained joint mob purpose & amp

reduce pain, no stress on capsule

gr 2 sustained joint mob purpose & amp

reduce pain, take up slack

gr 3 sustained joint mob purpose & amp

increase ROM, stretch

how to perform sustained joint mobs

joint in open packed position - stabilize proximal - apply steady traction/glide - hold then partially release - repeat 1-2 min

grade 1 sustained joint mob amp, duration

small hold, no stretch, 7-10s holds, repeat 1-2 min

gr 2 sustained joint mob amp & duration

take up slack, 7-10s holds, repeat 1-2 min

grade 3 sustained joint mob amp & duration

stretch capsule, 7s hold - partial release - repeat for 1-2min

joint mobilization general technique

open packed position - stabilize proximal - apply gr 2 distraction for safety check - if same/better proceed - if worse decrease to gr 1 - apply glide/distraction indicated - progress to gr 3 / 4 if stretching - reassess

force direction of glide

parallel to treatment plane

force direction of distraction

perpendicular to treatment plane

concave rule joint mobs

concave moving: glide same direction as bone movement

convex rule joint mobs

convex moving: glide opposite direction of bone movement

traction how to perform

client relaxed, limb supported - grasp distal segment - apply slow, steady pull along long axis - take up slack, maintaining gentle tension - release slow and evenly

traction purpose

decrease tone, improve proprioception , gently mobilize joint

traction side effects

mild stretch sensation, temporary soreness

how to perform skin rolling

pick up skin + superficial fascia between thumb and fingers - roll slowly along tissue

fascial spreading - how to perform

fingertips / thumbs contact the tissue - spread tissue in opposite directions - maintain slow, steady tension over the restriction

fascial torquing - how to perform

lift tissue between thumb and fingertips - twist tissue gently in one direction - hold until softening

s-bowing - how to perform

thumbs point toward each other - push tissue into an S shape - hold briefly then release

c-bowing - how to perform

thumbs together - push tissue into C shape - hold briefly then release

connective tissue cutting - how to perform

fingertips contact the tissue - pull tissue toward yourself in a slow, stripping like motion - move along line of restriction with controlled pressure

j-stroking - how to perform

use the PIP of 2nd digit - press into tissue and draw slow, deep J stroke - repeat 3-5 times over restriction

general fascial warmup

compressions + muscle squeezing - assess fascia (skin rolling / glide) - lengthen tissue

general fascial technique

take up elastic slack - slow, sustained load - hold until creep, softening, heat, hyperemia - slowly release - follow with soothing techniques

fascial techniques effects

release restrictions; increase mobility, elasticity, circulation; realign collagen

fascial technique side effects

burning / itching sensation, mild discomfort, redness / hyperemia, warmth, temporary tenderness

fascial technique risks

bruising, soreness after treatment, fatigue

effects of cross-fiber frictions

break down existing / forming adhesions

cross fiber frictions side effects

discomfort during technique, redness, temporary tenderness

cross fiber frictions risks

bruising, temporary increase in inflammation

joint mobilizations warm up

warm to kneading depth - safety check with gr 2 distraction (5s)

how to perform joint mobilizations

open-packed position - distract - add glide (oscillation or sustained) - maintain 1-2 min / until joint play improves

protocol oscillations gr 1 and 4

small, rapid; 1-2 min

protocol oscillations gr 2 & 3

large, slow (2-3s); 1-2 min

protocol sustained joint mobs

7-10s holds, 5-10 reps

traction protocol

10-30s hold, 3-5 reps

effects of joint mobs

pain reduction, increased joint play, reduced guarding, improved synovial fluid movement

passive stretch warm up

warm to kneading

how to perform passive stretch

stabilize proximal bone - move distal bone into stretch - hold 15-30s - repeat x3

effects of passive stretching

increase length, reduce stiffness

PNF / AIT warm up

brief petrissage - PROM to first barrier

PNF general how to perform

passively lengthen to first barrier - hold until client relaxes - contraction 5-10s - relax and move to next barrier - repeat x3

effects of PNF

reduces tone, increases ROM, uses autogenic / reciprocal inhibition to allow relaxation and elongation

isometric strengthening warm up

AFROM or light swedish

how to perform isometric strengthening

resist muscle action without joint movement - perform at 3 joint angles (inner - mid - outer)

protocol for isometric strengthening

reps: 7-10; sets: 3-5; hold: 5-7s

effects of isometric strengthening

early-stage strengthening, stabilization

isotonic strengthening warm up

AFROM

how to perform isotonic strengthening

concentric + eccentric through range; slow, controlled movement

isotonic strengthening protocol

reps: 7-10; sets: 3-5; duration: 5-7s contraction

isotonic strengthening effects

builds strength, functional loading

joint mobs side effects

mild soreness

risks of joint mobs

irritation, fatigue, temporary increase in symptoms

side effects of passive stretch

stretch sensation

risks of passive stretch

temporary soreness, cramping, fatigue

PNF / AIT side effects

stretch sensation, mild fatigue

risks of PNF

temporary soreness, cramping

isometric / isotonic strengthening side effects

muscle effort, temporary fatigue

risks of isometric / isotonic strengthening

cramping, temporary weakness

how to perform hold relax

first barrier - gentle isometric contraction of tight muscle for 5-10s - fully relax then move to next barrier - repeat x3 - if indicated, hold final stretch 30s; best for painful/guarded muscle

contract-relax - how to perform

first barrier - concentric isotonic contraction of tight muscle through small, pain-free range - maintain resistance while allowing movement (let them win slowly) for 5-7s - relax and move to next barrier - repeat x 3 - hold final stretch 30s if indicated; best when client can safely move through part of range

agonist-contract

first pain-free barrier of tight muscle - client actively contracts agonist (opposite) to move farther into stretch, guide movement so it is smooth and controlled - hold end of active movement 5s - relax and passively return to neutral - repeat 3-5 cycles, picking up new slack each time; best for muscle pain / guarding

hold relax / agonist contract how to perform

first barrier - gentle isometric contraction of tight muscle 5-10s - relax completely - immediately cue to actively contract the agonist to move farther into new range - hold end range for a few seconds - return to neutral, repeat 3 cycles; good for trigger points and very painful muscles

post-isometric relaxation - how to perform

first barrier - gentle (20%) isometric contraction of tight muscle 5-10s - fully relax and move to next barrier - repeat 3 cycles