Massage

what is massage?

- massage involves stroking, kneading, and pressing the soft tissues of the body with the hands

- used to stimulate circulation, relieve muscle tension, and promote relaxation

tui na

- therapy technique originating in china

- was first introduced in japan around 700 A.D. and overtime was modified and renamed Shaitsu "finger pressure" massage

ancient india

- massage was practiced in ancient india (1500 B.C.)

- hindus used a form of healing touch in the practice of Ayurvedic "life health" medicine

per henrik ling

- 1813

- father of sweedish gymnastics, physiologist, gymnastics instructor, and expert fencer

- founded the Royal Central Institute of Gymnastics (RCIG)

- combined his knowledge of physiology and gymnastics with chinese, egyptian, greek, and roman massage

- known as the swedish massage

johan mezger

- a dutch massage practitioner

- effleruage

- pertriassage

- tapotement

- friction

- vibration

albert hoffa

- german surgeon, orthopedist

- developed medical massage therapy (1893) "Hoffa System"

- treat soft tissue pain syndromes and dysfunctional joints/muscles

- commonly used in German Rehab hospitals

Society of Trained Masseuses

- england (1894)

- four nurses: lucy robinson, rosalind paget, elizabeth manley, margaret palmer

- 1920 became Chartered society of massage and medical gymnastics

- 1944 became the chartered society of physiotherapy

American Association of Masseurs and Masseuses

- formed in 1943 to legitimize massage therapy due to years of being associated with ill repute

- renamed in 1958: American Massage and Therapy Association

- 1983: American Massage Therapy Association

- massage therapy programs are 9 months to 1 year in duration, board exam

oil and massage

- oil allows hand to slide smoothly/evenly over contours of body w/out risk of friction

- only thin film of oil necessary to lubricate the skin

- grapeseed, sunflower, and safflower oil

pts skin and massage

- inspect the pts skin and your hands

- ask the patients' permission to touch them

- warm up your hands and place them over the body for a few seconds, and then slowly make contact

- hands should be relaxed, soft, and responsive

- keep one hand in contact at all times

- if you do, remove hands gently and slowly

- check in with pt

effleurage

- gentle rhythmic strokes glide over the skin, hands mold to the body using oil, used to begn and end massage for transition to other strokes

- allows therapist to assess underlying tissue

- can be used in acute conditions to improve circulation and. lymphatics, reduce swelling, inhibit pain, and promote healing

- in chronic conditions, it can be used at the beginning and at the end of treatment to provide entry and exit from mechanical techniques

- hour glass

- shingling

- horizontal stroking

petrissage

- much deeper than effleurage strokes

- lifting and squeezing of soft tissues in a kneading motion, or pressing or rolling of the tissues

- no gliding over the skin except between progression from one area to another

- do a few effleurage strokes after to smooth out the area

friction

- deep petrissage type stroke

- often used over tense ropy muscle where a spams has been detected (trigger points)

- small circular movements with fingertips, thumb or heel of hand

- no gliding occurs between the skin and finger/hand, only the under tissue is moved

tapotement

- consists of brisk hacking or fisting motions using the lateral aspect of the hands, fists, or cupping of the hands

- light, rapid, rhythmic, alternating motions

- the pressure is quite light, should not cause pain or the patient to gasp

- usually performed over a sheet

- used for stimulation purposes not relaxation/pre-sports

vibration

- small amplitude oscillations of the underlying tissue

- large amplitude rocking motions of a limb or the whole body (rebounding)

- used to release tissue fibrosis or habitual muscle holding patterns

indications for massage

- establish connection with patient through touch

- early after injury to improve circulation, remove by products of inflammation, and prevent congestion

- reduce pain via neural gating mechanism/ pain modulation

- improve sleep patterns

- in combination with passive ROM encourages organized healing of connective tissue

- use as a stepping stone to more aggressive, mechanical work

- in more chronic conditions use at the beginning and at the end of treatment to provide entry and exit from mechanical techniques

contraindications for massage

- bleeding disorder or blood-thinning medication

- burns or healing wounds

- DVT

- fractures

- severe osteoporosis

- over cancer or tumor

how does massage work

- stimulation of sensory receptors in the skin and superficial fascia activates the parasympathetic nervous system that inhibits bodily processes

- creates a relaxation response that reduces BP, slows respiration, decreases the production of stress hormones, and causes muscle relaxation

- capillaries dilate increasing blood flow and improving lymphatic circulation

- enhances the delivery of oxygen and nutrients and eliminates waste products

- facilitates healing

pain neuroscience education

- pain perception

- not always a tissue issue

- nervous system remains in a state of hyperexcitability after injury has healed

allydonia

- presence of pain response to a stimulus that shouldn't provoke pain

hyperalgesia

increased sensitivity to pain

central sensitization orders

- fibromyalgia

- chronic fatigue syndrome

- IBS

- TMJD

- Tension Headache/migrane

- chronic low back pain

- complex regional pain syndrome (CRPS)

threshold of pain

- typically goes back to normal as tissue damage is healed

- sometimes it can not go back to baseline after healing

resilient person vs vulnerability

nocioceptive pain

- mechanical

- temperature

- chemical

- electrical

peripheral neurogenic pain

- outside of the dorsal horn

nocioplastic pain/centrally sensitization

- the nervous systems remain hypersensitive after the injury has healed

cognitive and affective tendencies

- fear

- catastrophizing

- hypervigilance

- anxiety

- depression