Massage (P.433,453-458)

Massage definition

• systematic manipulation of the soft tissues of the body.

• movements of gliding, compressing, stretching, percussing, and vibrating are regulated to produce specific responses in the patient.

Mechanical responses

direct result of the graded pressures and movements of the hand on the body.

• Such actions encourage venous and lymphatic drainage and mildly stretch superficial and scar tissue.

• Connective tissue can be stretched effectively by deep tissue friction massage, which helps prevent rigidity in scar formation.

• When a patient is forced to remain inactive while an injury heals or when edema surrounds a joint, the stagnation of circulation may be prevented by using certain massage techniques.

Physiological responses

• Massage can increase circulation and, as a result, increase metabolism to the musculature and aid in the removal of metabolites.

• It also helps overcome venostasis and edema by increasing circulation at and around the injury site, assisting in the normal venous blood return to the heart.

• The tactile system

The tactile system (PR)

• one of the most sensitive systems in the human organism.

• From earliest infancy, humans respond psychologically to being touched.

• Because massage is the act of laying on of hands, it can be an important means for creating a bond of confidence between the athletic trainer and the patient.

The reflex effects of massage

• response to nerve impulses initiated through rubbing the body, are transmitted to one organ by afferent nerve fibers and then back to another organ by efferent fibers.

• elicit a variety of organ reactions, such as body relaxation, stimulation, and increased circulation.

Relaxation

induced by slow, superficial stroking of the skin. It is a type of massage that is beneficial for tense, anxious patients who may require gentle treatment.

Stimulation

quick, brisk action that causes a contraction of superficial tissue.

• The benefits derived by the patient are predominantly psychological. He or she feels invigorated after intense manipulation of the tissue.

Increased circulation

accomplished by mechanical and reflex stimuli.

• Together they cause the capillaries to dilate and be drained of fluid as a result of firm outside pressure, thus stimulating cell metabolism, eliminating toxins, and increasing lymphatic and venous circulation. In this way the healing process is aided.

Effleurage

• light stroking

• Deep stroking

• Can we use both methods (stroking)

• Different hand methods

• Pressure

Light stroking (effleurage)

• sedative

• Early stages of injury treatment

deep stroking (Effleurage)

therapeutic compression of soft tissue

• venous and lymphatic drainage

Can we use both (stroking methods?) {Effleurage}

yes can be used alternately when both features are desired

Different hand methods (Effleurage)

• hand-over-hand method

• Cross body technique

hand-over-hand method (Effleurage)

One hand strokes followed by another (shingles on a roof)

• benefit surface areas that are unyielding

Cross body method (Effleurage)

Hand on each side of spine both stroke simultaneously

• excellent low back region

Pressure (Effleurage)

very light -> deep and vigorous

Petrissage

• kneading

• a technique adaptable primarily to loose and heavy tissue areas (e.g., the trapezius, latissimus dorsi, or triceps muscles).

• The kneading action wrings out the muscle, thus loosening adhesions and squeezing congestive materials into the general circulation.

Petrissage technique

picking up the muscle and skin tissue between the thumb and forefinger of each hand and rolling and twisting them in opposite directions. As one hand is rolling and twisting, the other begins to pick up the adjacent tissue.

Petrissage (important)

Picking up skin may cause an irritating pinch. Whenever possible, deep muscle tissue should be gathered and lifted.

Friction

• used often around joints, other areas tissue is thin and tissues that are especially unyielding

• action is initiated by bracing with the heels of the hands, then either holding the thumbs steady and moving the fingers in a circular motion or holding the fingers steady and moving the thumbs in a circular motion.

  • Each method is adaptable to the type of area or articulation that is being massaged.

• The motion is started at a central point, and then a circular movement is initiated, with the hands moving in opposite directions away from the center point.

Friction most common uses

scares, adhesions, muscle spasms, fascia

Is friction adaptable?

Each method is adaptable to the type of area or articulation that is being massaged.

Purpose of friction

The purpose is to stretch the underlying tissue, develop friction in the area, and increase circulation around the joint.

Tapotement

• cupping

• Hacking

• Pinching

Cupping (Tapotement)

• an invigorating and stimulating sensation.

• It is a series of percussion movements rapidly duplicated at a constant tempo.

  • The hands are cupped to such an extent that the beat emits a dull and hollow sound, unlike the sound of the slap of the open hand. The hands move alternately, from the wrist, with the elbow flexed and the upper arm stabilized

• The cupping action should be executed until the skin in the area develops a pinkish coloration.

Hacking (Tapotement)

• can be used in conjunction with cupping (bring varied Stim. Sensory nerves)

• Only heavy muscle areas treated in this manner

  • similar to cupping except that the hands are rotated externally and the ulnar, or little finger, border of the hand is the striking surface.

Pinching (Tapotement)

lots of vigorous

• Alternating hands lift small amounts of tissue between the first finger and thumb in quick, gentle pinching movements

Vibration

• produces quivering/trembling effect

• Used relax and soothe

• Can be done manually or machine vibrator (preferred modality)

Special considerations (vibration)

• confined to specific area, seldom given to whole body

• Time to give full body massage = excessive (usually only need 5 minutes)

Massage lubricants

• allow hands to slide easily over body not cause irritation (tearing, pulling on hair)

• Many media (powder, oil, petronium base) = lubricant

Position patient

• injured part = accessible

• Patient must be comfortable

• Must be relaxed

Confidence

must be confident = give the appearance you know what your doing

Ensuring patient privacy

• make sure touch is appropriate

• Only expose body part being treated

• Can have another trainer in there to watch over

Deep transverse friction massage

• treating muscles, tendons ligaments, joint capsules

• Move transversely across ligament or tendon to mobilize it as much as possible

• Precise active exercise

• Restores mobility to a muscle same way mobilization frees a joint

Application (DTFM)

• important gaining maximum strength, control

  • index finger crossed over middle finger, middle finger crossed over index finger, two fingers side by side, opposed finger and thumb

• must be over the site of lesion and pain

  • fingers move with the skin don’t slide over it

  • Must be across the grain (tissue)

  • Thicker the surface, more friction given

  • Sweep back and forth (full width of tissue)

Special considerations (DTFM)

Should not be given to acute injuries, over highly swollen tissues

Acupressure Massage

• type of massage based on ancient Chinese art acupuncture

• Effectiveness attributed likely to interaction of various mechanisms of pain modulation

Application (AM)

• has charts to select specific points that have some relationship to the specific area of pain

• Ohmmeter may be used to locate the points, Simplest easiest technique = simply palpate area (feels small, fibrous nodule or strip tense muscle tissue (tender touch))

• Point located = massage (index, middle finger, thumb, elbow, circular motions) - sub maximal pressure (1-5 minutes single point/treatment, do many points to get the best treatment)

Special considerations (AM)

• During massage dulling, numbing effect (indicate pain diminished or subsided)

• Lingering effects vary tremendously (patient -> patient)

  • can last minutes to hours

Percussive Massage

massage + vibration therapies

Application (M+Vb)

• hand-held devices

• May be used for both self-massage, massage by clinician (warm up-recovery)

• Can be adjusted to vibrate different frequencies

• Attach different heads

Special considerations (M+Vb)

literature on percussive massage is primary anecdotal and very little scientific-based evidence (benefits, indications, contraindications, side effects)

Dry needling

• inserting thin, solid filament needle through skill (myofasical trigger point) within the muscle

• No injection of medication

• Acupuncture = same needs, but treats not only muscular conditions but also many non-muscular medical conditions

• Dry needing = treating pain with myofasical trigger points

  • sensation = similar to muscle cramp (twitch response)

• limited amount of studies say works as anaesthetic

Cupping therapy

• roots in several cultures dating back 3000bc

• Improve blood flow, reduce swelling, reduce pain, treat scar tissue

• Can help with localized disease, systematic diseases

Dry cupping

medical grade cups of glass, silicone, or rubber (create suction to skin)

• mechanical pump or heat (suction)

Mechanical pump (Dry cupping)

Lower air pressure in the cup = vacuum draws skin upwards and Redding as the blood vessels expand in the cup

Heat (Dry cupping)

• Heating air inside the cup = flame -> placed against skin

• Air cools = vacuum

Wet cupping

• suction is created in the cup = 3-5 minutes -> remove cup -> scape to make incisions superficially in the skin -> vacuum (suck out blood)

• Antibiotics after = prevent infection

Vibration therapy

enhance muscle function, somatosensory function, balance, bone health, cartilage health, flexibility, patient report outcomes (targeting sensory receptors {muscles, skin, joint, bone})

Application (VT)

• 30-60 seconds over a frequency 10-100Hz, mag = 0.1-10g, amp = 2-9mm

• applied directly (local vibration) or indirectly (whole body vibration)

Local (VT)

• small device = hand-held or secured to patron

• Small oscillator (vibratory stimulus)

Whole-body (VT)

stationary platform = cyclically accelerates the body upwards

Special considerations (VT)

• benefits have been shown several times (anterior cruciate ligament injury, functional ankle instability, Parkinson's disease, and multiple sclerosis)

• Benefits are noted in clinical pop. (Not healthy individuals)

Equipment (Ice massage p.433)

• Towel = absorb water collected

• water frozen foam, waxed paper cup (cylinder of ice)

• Foam removed inch top of cup, rest cup = handle grasp while massaging

Or

• fill cup with water, insert tongue depressor (handle) water frozen.

Indications (Ice massage p.433)

used tendons, muscle, bursae, myofasical trigger points

Application (Ice massage p.433)

• cyotherapeutic method

• Rub ice over patients skin (overlapping circles) 5-10 minutes

• Should experience cold, burning, aching, numbness.

• When analgesia = engage in stretching, or exercise

Special considerations (Ice massage p.433)

• tissue damage seldom occurs (cold application)

• Temperature of the tissue seldom = below 59F* (15C)

• If somebody is going to have an adverse reaction (cold) = happens early treatment

• Shortens recovery time (following strenuous exercise)

• Comfort of patients = considered all times