Ch. 10

Learning Objectives

• LO 1 Describe four forces that deform tissue for therapeutic gain.
• LO 2 Describe the seven major categories of massage methods.
• LO 3 Outline the fundamental movements for the seven major categories of massage methods.
• LO 4 Explain and demonstrate how each factor plays a part in therapeutic massage: intention, direction, speed, length, duration, rhythm, and pressure.
• LO 5 Demonstrate mastery of basic massage movements. Demonstrate passive and active joint movements.

Introduction

• Massage movements are to therapeutic massage what words are to language or notes to music. Understanding movements is imperative to practice.
• Mastery of movements enables the therapist to create a personalized work of art for each client and to combine movements according to client needs.
• There are countless massage manipulations and possible stroke combinations; routines can be standard or specialized.
• Beyond the movement of the hands, the continuous interaction of client and therapist, and the intent with which each manipulation is delivered, affect the delivery and outcome of the massage.

Forces Impacting Tissue Deformation

• Define soft tissue deformation as the change in the shape of soft tissues resulting from external or internal forces.
• Internal forces may come from muscle tension or gravity pulling on tissues; external forces come from applied manipulations.
• Loads are created when forces push or twist soft tissues; improper intensity can injure tissue (too much) or be ineffective (too little).
• The soft tissues directly affected include the skin, subcutaneous fascia, deep fascia (myofascia), muscle, nerves, nerve endings, blood vessels, and lymphatics; energy meridians may also have indirect reflex effects.
• Knowledge of anatomy and physiology (skeletal, muscular, fascial, nervous systems) helps the therapist decide which strokes to use for a positive outcome.
• External forces may be categorized as follows:
  • Compressive forces (compression): pressing perpendicularly into tissues against underlying bone.
  • Tensile forces (tension): elongation, pulling tissue layers apart.
  • Twisting forces (torsion): compressing and twisting one end while the opposite end is held or twisted in the opposite direction.
  • Shearing forces: moving different tissue layers against each other.
• Forces are often applied in combination to deform tissues positively; intensity must be appropriate to avoid injury.
• Compression can shorten a muscle, affect ligaments, organs, and nerves, and may be used to assess tissue receptivity, mobility, and density, as well as to enhance local circulation or sedation.
• Tensile forces elongate tissue, reduce adhesions, and improve range of motion; excessive tensile force can cause injuries (ligaments, muscles, nerves).
• Torsion (twisting) helps break adhesive bonds between fibers and promotes pliability.
• Shearing forces deform tissue by sliding layers against each other, helping to break adhesions and improve pliability.

External Forces: Detailed Categories

• Compressive forces (compression)
  • Deform tissues by pressing perpendicularly into tissues against bone.
  • Properly dosed compression improves local circulation and can be used as an assessment tool.
  • Special techniques like position release or strain-counterstrain use end-range compression with controlled tissue shortening to reset neural/proprioceptive feedback.
• Tensile forces (tension)
  • Elongate tissue, separate fibers, and improve elasticity.
  • Risks include ligament sprains, muscle strains, and nerve traction injuries with excessive force.
  • Applied by two-hand engagement, traction, or stretching with little lubricant to elongate tissue between hands.
• Twisting forces (torsion)
  • Apply compression and twist one end while the other is held, creating torque.
  • Commonly seen in kneading and wringing techniques; helps break bonds and improve pliability and local circulation.
• Shearing forces
  • Move tissue layers against each other or across one another, often using friction techniques.
  • Generate heat and promote tissue pliability; help reorganize collagen and improve tissue mobility.

The Seven Common Massage Methods

• Static methods
• Gliding methods
• Torsion methods
• Shearing methods
• Oscillating methods
• Percussive methods
• Joint movement methods

Static Methods

• Definition: deform soft tissue by holding hand positions for a fixed length of time.
• Can use fingertips, entire hand, thumb or braced thumb, forearm, or elbow.
• Static methods may involve resting the hand on the body, pressing into a pressure point, or holding the body so no visible movement occurs.
• Therapeutic purposes include establishing trust, sedating or stimulating the nervous system or subtle energy systems.
• Examples include stationary touch, ischemic compression on trigger points, and holding methods in Position Release and Muscle Energy Techniques (MET). (Chapter 15 covers these in Clinical Massage Techniques.)
• Static methods can stabilize a body part to create a fulcrum point or limit motion to allow other movements.

Gliding Methods

• Definition: a smooth, continuous stroke with contact maintained; pressure can be light, moderate, or deep; sometimes called energy or aura strokes when very light.
• Gliding may use fingertips, palm, hand, soft fist, or forearm.
• Gliding serves to introduce touch, assess tissue quality, identify irregularities, distinguish tissue types, and facilitate deeper work by moving through tissue strata (aura to periosteum).
• Pressure deepens with time to reach deeper tissues.
• Variants of gliding (effleurage/petrissage terminology, though modern terms are gliding and kneading):
  1. Aura gliding: long strokes; hands come close but do not touch; direction along the body; return stroke is farther from the body; aims to affect energy fields; soothing; used when client is receptive; often final stroke.
  2. Feather gliding: very light fingertip touch; outward strokes; often a completion stroke; two or three strokes can be slightly stimulating; more repetitions sedating.
  3. Superficial gliding: light touch; used to acquaint client with touch and prepare tissue for deeper work; gliding warms tissue and assesses surface.
  4. Deep gliding: deeper pressure and mechanical effect; uses palms, thumbs, knuckles, or forearms; depth depends on tissue condition and movement intention; care with body mechanics to avoid injury.
• Gliding application details:
  • Large surfaces (limbs, back, chest, abdomen): use palmar surfaces or forearm.
  • Small areas (face, hands): use fingers or thumbs.
  • Very deep gliding: use palms, thumbs, knuckles, or forearm.
• Direction and systemic effects:
  • Gliding toward the heart (centripetally) enhances venous and lymphatic flow and is generally relaxing.
  • Gliding away from the heart is more stimulating.
  • Gliding across fiber orientation helps stretch tissue and soften adhesions.
• Uses of gliding:
  • Assess tissues, spread lubricant, and prepare tissues for deeper work; engage superficial and deeper tissue layers; facilitate local fluid movement.
• Gliding effects vs depth:
  • Superficial gliding tends to have reflexive effects (nervous system calm); deep gliding has mechanical effects (tissue elongation, fascial stretch).
• Practical notes:
  • Gliding should be performed with proper body mechanics; movement should originate from the body rather than the arms.
    -Pressure selection must respect client comfort; avoid bruising or tissue damage.

Kneading Movements (Torsion Methods)

• Kneading or Petrissage (from the French petrir, meaning to knead or mash)
  • Uses a torsion force (torque) by compressing and twisting tissue ends in opposite directions.
  • Applied on fleshy areas; helps move fluids in deeper tissues; softens superficial tissues; reduces adhesions; stretches muscle tissue and fascia; can help maintain muscle tone and potentially reduce atrophy.
  • Application: large areas use alternating hands; tissue is lifted with the palmar surface of one hand into the opposite palm, then reversed; on smaller structures (arms), grasp between fingers and palm; on very small structures (hands, fingers), hold tissue between thumb and fingers.
• Fulling
  • Kneading technique where tissue is grasped, lifted, and spread to create space between layers.
• Skin rolling
  • Variation where only skin and subcutaneous tissue are picked up between thumbs and fingers and rolled; no lubricant initially; warms and stretches superficial tissues to begin separating fascial adhesions; hands progress along surface while the thumb glides.
• Wringing
  • Back-and-forth movement with hands a short distance apart on either side of a limb; tissue is stretched and twisted against the bone in opposite directions; whole body engages in movement; pressure is moderate.
• Rolling
  • Rapid back-and-forth movement where flesh is shaken and rolled around the axis of the body part to warm and relax tissue; promotes deep muscle relaxation.
• Chucking
  • Flesh is grasped firmly and moved up and down along the bone in quick series; often used on arms and legs; helps loosen tissue along axis of limb.
• Effects and benefits of torsion methods
  • Mechanically loosen and soften superficial tissues; improve local fluid movement; broaden and stretch local tissues; improve muscle tone and elasticity; reduce muscle atrophy.

Skin Rolling, Wringing, and Other Frictions (Expanded Torsion-Related Techniques)

• Skin rolling provides a myofascial-oriented prep step and can be integrated with other methods to separate adhesions and increase tissue mobility.
• Wringing stretches and warms connective fascia, preparing tissues for deeper work.

The Shearing Methods (Friction Techniques)

• Friction strokes can be superficial or deep and are used to warm and affect deeper tissues; heating stimulates tissue activity and helps separate tissue layers.
• Four main friction-related movements and their variants:
  • Superficial friction: brisk back-and-forth strokes, typically over a larger area with palm, sometimes both hands; no lubricant; heat is generated by resistance.
  • Deep friction: moves superficial layers against deeper tissues; presses layers together to flatten, broaden, or stretch tissue; generates heat and increases metabolic activity.
  • Circular friction: small circular patter n used to warm the area and prepare for deeper work; does not slide across tissue; useful for palpation.
  • Cross-fiber friction (transverse): applied across muscle, tendon, or ligament fibers to broaden, separate adhesions, break down scar tissue, and align fibrous tissue; target tissue is approached with sufficient breadth but not so broad as to snap fibers.
  • Longitudinal friction: moves with the direction of tissue fibers to align collagen fibrils within fascia.
• Rolling, chucking, and compression are also described as friction-based movements or adjacent to friction techniques.
• Benefits and effects of friction methods
  • Heat production increases metabolic activity and fluid exchange.
  • Friction helps separate tissues, soften adhesions, and reduce fibrosis, especially in muscle and fascia.
  • Improves local circulation and glandular activity; redness (hyperemia) often occurs due to histamine release.
  • Properly applied friction can improve tissue pliability and functional movement.

Oscillating Methods

• Oscillating methods involve back-and-forth or rocking motions that create momentum to affect tissues.
• Types include:
  • Shaking: rapid lateral or horizontal shaking of a relaxed body part to release tension; used by Trager work to locate and release tension.
  • Jostling: releasing muscle tension after exertion; grasps muscle, lifts slightly, and shakes quickly across its axis.
  • Rocking: push-pull-release motion, side-to-side or up-and-down; calming and soothing; adapt rhythm to client.
  • Vibration: continuous trembling or shaking movement; can be manual or mechanical; used to desensitize points or areas; avoids bony areas; larger muscles are typical targets.
• Mechanisms and equipment
  • Manual vibration uses fingertips or palms; mechanical vibrators vary (oscillating, orbital, thumper).
  • Rates: manual approximately 5–10 cycles per second; mechanical 10–100 vibrations per second, depending on device.
  • Mechanical vibrators come in various sizes, including small strap-on devices and floor-standing units with adjustable heads.
• Effects of oscillation
  • Generally soothing at light intensity; stimulating with higher intensity; can be used to relax tissues or stimulate peristalsis depending on the frequency and pressure.

Percussion Methods (Tapotement)

• Percussion methods are quick, rhythmic striking manipulations designed to stimulate the body.
• They do not use heavy force but rely on a rapid, glancing contact with the body.
• Typical forms include:
  • Tapping with fingertips
  • Cupping (cupping) with the cupped palm
  • Slapping with the flat of the hand or fingers
  • Hacking with the ulnar border of the hand
  • Beating with a softly clenched hand
• Effects and uses
  • Tonify muscles, promote a healthy glow, and stimulate the treatment area.
  • With each strike, muscles contract briefly and then relax as the hand leaves the body.
  • Percussion moves should avoid spine, excessively contracted muscles, or sensitive areas (e.g., kidneys).
• Practical notes
  • Avoid percussion directly over the spine or injured tissues.
  • Use rhythm and appropriate intensity to avoid discomfort.

Joint Movement Methods

• Joint movements involve moving joints through their range of motion (ROM).
• Two main categories:
  • Passive joint movements (PJM): practitioner moves the joint while the client remains relaxed; used for assessment of ROM and improvement of mobility; always work within client comfort.
  • Active joint movements: client actively participates; can be subdivided into:
  • Active assistive movements: client attempts a movement; therapist assists to complete the movement; repeated several times.
  • Active resistive movements: client performs movement with the therapist applying resistance; used to build strength and improve coordination.
• Benefits of joint movements
  • Restore mobility and increase flexibility; promote synovial fluid production for joint lubrication; stimulate lymph and blood flow in the area; enhance overall movement potential.
• Combination approaches
  • PJMs are often combined with active movements (e.g., shoulder ROM work: client attempts elevation, therapist assists, then reduces assistance for active range).
• Proprioceptive Neuromuscular Facilitation (PNF), Muscle Energy Techniques (MET), and Proprioceptive Facilitation Techniques (PNF) are discussed as part of joint movement modalities and are covered in Chapter 15 (Clinical Massage Techniques).

Factors Influencing Massage Strokes (LO 4)

• The manner in which strokes are applied determines the speed, length, duration, rhythm, and pressure of each stroke; intention and direction influence effects.
• Therapeutic Intention
  • Intention is the mindful process of choosing and implementing a treatment strategy.
  • The therapist’s intention affects stroke selection; examples:
  • General relaxation: long gliding strokes with slow, steady rhythm.
  • Pain relief or increased flexibility: different techniques and timing are chosen.
  • Pre-massage interview and assessment influence the intended outcomes (infant massage vs sports massage).
• Engaging the Tissues
  • Engaging the tissues means working with and into the tissue layers; the therapist senses tissue integrity, sinks deeper, responds to feedback, and communicates with the tissues for therapeutic benefit.
  • Engagement requires noninvasive, sensitive touch and tissue communication.
• Direction
  • Strokes toward the heart enhance venous and lymphatic circulation, reduce edema, and are generally relaxing.
  • Strokes away from the heart or into the tissues tend to be more stimulating.
  • Strokes across fiber orientation help stretch tissue and soften adhesions.
• Speed
  • Speed relates to the massage intention; quicker strokes tend to be invigorating or stimulating, while slower, rhythmic strokes tend to be relaxing.
• Length (Excursion)
  • The distance a stroke travels; gliding can cover entire limbs or smaller segments; longer strokes on larger areas, shorter strokes on localized areas (e.g., face).
• Rhythm
  • Individual rhythm affects treatment; adapt to client’s natural rhythm and needs (some clients are tense, others relaxed).
  • Rhythm should align with client’s pace to maximize therapeutic effect.
• Breathing
  • Breathing should be monitored and guided; encourage clients to take several full, relaxing breaths at the start; maintain awareness of both client’s and therapist’s breathing during the session.
• Duration
  • Duration refers to how long a stroke is performed on an area or the overall session length; avoid over-fatiguing an area.
  • A typical full-body massage should last about one hour; distribute strokes to cover all intended areas within time.
• Pressure
  • Pressure should be adapted to tissue condition and technique; begin gently and progressively deepen as tension allows.
  • Seek client feedback and watch body language; avoid abruptly crossing pain thresholds; adjust pressure gradually when pain is present or dissipating.
  • Pressure can be diffuse (broad surfaces) or concentrated (thumbs, knuckles, elbows) depending on the intended effect.
• Depth
  • Depth of a stroke depends on movement, direction, tissue density, condition, and goals.
  • The depth must be appropriate to the tissue; more relaxed tissues allow deeper penetration; always follow the rule: Do no harm.
• Practical note
  • Throughout the session, adjust these factors in concert to achieve the intended outcome while maintaining client safety and comfort.

Effects and Benefits of Massage Movements (LO 5)

• The following describe typical effects and benefits of movements (general tendencies, not universal outcomes):
• Static touch and light touch
  • Light touch can reduce pain, lower blood pressure, calm nervous irritability, and reassure tense clients; used when contraindicated for full techniques.
• Deep static touch
  • Deep pressure can calm or stimulate depending on context; effective for soothing spasms and reducing trigger points; requires careful adherence to pain tolerance and sound body mechanics.
• Gliding (Effleurage) and superficial gliding
  • Gliding strokes distribute lubricant, assess tissue quality, and promote local fluid movement; superficial gliding prepares tissue for deeper work; deep gliding stretches tissue and fascia and enhances local circulation.
• Superficial gliding vs. deep gliding
  • Superficial gliding is soothing; deep gliding provides mechanical effects; both require proper body mechanics to avoid injury.
• The direction of gliding affects tissue response and energy flow.
• Fascia and deeper tissues respond to gliding with warmth and stretch; excessive force can trigger protective muscular contraction.

Massage Corner 10.1: Terminology for Effleurage and Petrissage (Gliding and Kneading)

• Four varieties of gliding depending on intention and depth:
  1. Aura gliding: long, near-touch strokes along the body's length with one direction; usually without contact on return stroke.
  2. Feather gliding: light fingertip touch, often used as a completion stroke to calm nerves.
  3. Superficial gliding: light pressure, broad area coverage.
  4. Deep gliding: church-appropriate depth to achieve mechanical effect.
• Gliding can be performed with various parts of the hand (fingers, thumbs, palms, knuckles, forearm) and on different body regions (large surfaces vs. small areas).
• Aura gliding is especially associated with energy-field concepts and is typically used when environment is quiet and client is receptive; used as a final stroke in some sessions.
• Feather gliding (nerve strokes) uses very light pressure from the center outward; a few repetitions may be slightly stimulating, more repetitions lead to sedating effects.
• Deep gliding uses enough pressure to affect the mechanical properties of tissues; must respect client comfort and body mechanics; depth is influenced by tissue density and duration.

Depth and Positioning in Gliding

• When applying deep gliding, pressure should be maintained with a relaxed hand and a stable body posture; movement should originate from the therapist’s core, with shoulders down and wrists aligned to avoid joint strain.
• The direction of gliding (centripetal toward the heart) tends to promote relaxation and circulation; return strokes are lighter and away from the center.

Effleurage and Petrissage Terminology (Recap)

• Effleurage: gliding strokes commonly used as the traditional term for Swedish gliding movements.
• Petrissage: kneading movements formerly known as kneading; used to describe kneading-type gliding on fleshy areas; modern terminology uses gliding and kneading.

Depth and Movement Direction ( summarized )

• The depth of a movement is a function of: the movement type, the tissues involved, the direction of movement, and the amount of pressure applied.
• Deeper tissue work requires accurate body mechanics and proper direction to avoid joint strain and tissue damage.
• Always prioritize the client’s safety and comfort; depth should be adjusted to achieve therapeutic goals without exceeding pain tolerance.

End Feel and Barriers to ROM (Joint Movements Section)

• Joint movements are useful as assessment tools and for mobility/ROM improvements.
• Barriers to ROM (natural limits on movement)
  • Anatomic barriers: structural limitations of the joint; crossing beyond them can cause tissue damage.
  • Physiologic barriers: encountered at the approximate end range; due to bone-to-bone contact or soft tissue limitations (muscles/ligaments); soft tissue approximation is common.
  • Pathologic barriers: barriers caused by disease, injury, inflammation, or scar tissue; usually present before achieving the normal end of ROM and can be painful.
• End feel: the qualitative sensation at the end of ROM; provides information on normal vs abnormal joint function.
  • Hard end feel: bone-on-bone contact, abrupt limitation.
  • Soft end feel: cushioned limitation due to soft tissues; slight give before reaching end range.
  • Empty end feel: movement is limited or painful before reaching the physiologic barrier; indicates pathology or pain-limiting conditions.
• ROM assessment uses end feel to determine functional status and guide treatment planning.
• Joint movements are integral to soft tissue modalities and are foundational for PNF, MET, and Position Release; further discussion in Chapter 15 (Clinical Massage Techniques).

Notes on Practical Application and Ethics

• The practitioner must continuously monitor tissue response, client feedback, and body language; adjust techniques to avoid pain beyond the client’s pain threshold.
• Effective massage balances therapeutic goals with client comfort, safety, and psychological readiness.
• The art of massage includes recognizing when to shift from deep, mechanistic work to more soothing, grounding touches based on client needs and responses.