Classic Massage

  1. Classic massage

- physiological effects

- What are these???

- indications

- mild musculoskeletal pain relieved by rest

- not irritable acute pain caused by motion but disappears quickly (NOT A FRACTURE

- soft tissue tightness/adhesions

- contracture

- edema/ effusion (NOT TOO MUCH)

- pain relieved or provoked by specific movement

- relief when altering posture

-  expected outcomes

- What are these??? 

  1. Discuss general principles of massage 


- professional demeanor

- dress professionally 

- no jewelry 

- Nails trimmed

- no irritating perfumes

- professional language 

- touching another person

- pt. Modesty 

- draping 

- allow dress and undress in privacy 

- comfortable room temp

- avoid anything that could be misconstrued as inappropriate  

- permission to touch

- tell whats going on and get permission

- gender issues

- prefer physician of same sex

- could be cultural 

- talking and feedback

- look at 3

- confidentiality.

  1. Describe the desirable physical environment for massage.

  • Comfy room temp.

  • Relaxing music

  • Music pt. Likes

  • Talking to minimum 

  • No talking about self

  • Ask for pt. Feedback 

  • Calm tone

  • Allow pt. to talk but only appropriately 

  • If pt. Cries, not a big deal

  1. Differentiate among the different topical substances used in massage 

  • Advantages 

    • What are the advantages??

  • Disadvantages

    • Topical substances

      • Allows hands to slide over hands freely 

      • Consider allergies

      • Tell pt. What you use or whats in it

  • Lotions

    • Dry out quickly

  • Oils

    • Stain clothes

    • Stain sheets

  • Free up

    • Specific for message 

    • Doesn’t dry out

    • Comes off with towel

    • No staining

    • Will stain khakis 

  • Friction

    • No substance on skin

  • USE BASED ON OUTCOME YOU WANT

  1. Differentiate among the classic massage techniques

  • All are done from distal to proximal

  • Effleurage

    • At the beginning 

    • Light strokes

    • Base of palms

    • Long strokes in circles

    • Tissues ready for more intensive

    • Increases blood flow

    • End with

  • Petrissage

    • Deeper stroke

    • Heels of hands

    • As you go up, fold fingers, pick up section of skin and muscle

    • Roll it under hands

    • “Kneading” 

    • Good for lymphatic return

    • Removes metabolic waste

  • Friction

    • Remodeling scars

    • Quick transverse motion

    • Reverse adhesion of scar tissue

  •  Tapotement

    • “Percussion”

    • Stimulation circulation

    • ‘Peripheral nerve endings

    • Respiratory issues (loosens mucus in airways, cystic fibrosis

  • Vibration.

    • RAPID

    • Stimulates circulation

    • Relaxes tissue

    • Reduce muscle soreness

    • Is intense 

    • Used by athletes

  1. Discuss/demonstrate safety precautions and comfort issues affecting both the patient and the practitioner before, during, and after the application of classic massage techniques and the appropriate action to be taken within the established plan of care.

  • Good body mechanics

  • Ask if pt. Allergic to latex (in free up)

  • Ask about contraindications

  • Don’t use tips of fingers

  1. Demonstrate the safe application of classic massage techniques as delegated by the physical therapist within the plan of care using proper body mechanics and responding appropriately to endangerment sites, precautions, and contraindications in patient-simulated activities.

  2. Identify data collection techniques used by the physical therapist assistant to monitor status and determine patient response to classic massage within the established plan of care, including pain rating and skin condition before and after the application of classic massage techniques.


Contraindications; soft tissue mobilization

  • Bacterial infection

  • Malignancy

  • Systemic infection (not of musculoskeletal origin)

  • Recent fracture

  • Cellulitis

  • Fever

  • Hematoma (bruise)

  • Advanced diabetes (loss of feeling in extremities and can’t give feedback)

  • Hypersensitivity (not pleasant so neither relaxing or relieves pain; older pt.s with bad skin integrity)

  • Open wound (in it)

  • Osteomyelitis (infection of the bone)

  • Circulatory conditions

  • Inappropriate end feel

  • Constant and severe pain

  • Radiating pain 

  • Pain not relieved by rest

  • Pain triggered and not relieved within a few hours

  • Congestive heart failure



Precautions

  • Joint effusion/ inflammation

  • Rheumatoid arthritis 

  • Neurological signs 

  • Osteoporosis

  • Hypermobility

  • Pregnancy (thoracic)

  • Dizziness (laying down makes inner ear issues worse)

  • steroid/ anticoagulant therapy (blood thinner, bruising)



Clinic considerations

  • Good body mechanics

  • Consider length of treatment

  • Manage time

    • 10 minutes - 1 hour

  • Don’t use to much lube or not enough

  • Dry towel to clean

  • Give pt. Dry towel to clean 

  • Modesty

  • Appropriate sequence of technique 

Manual lymphatic draining (MLD) aka “Retrograde message” 

  • Post surgery

  • Lymphatic vessels block

  • Helps move fluid along body 

  • Helps with healing

  • Helps with swelling 

  • Distal to proximal

  • Comfortable; efferage 

Contraindications

  • Congestive heart failure

    • Could cause heart attack 

  • Active cancer, systemic cancer

  • Acute inflammation that could tear skin

  • Blood clot



Instrument assisted soft tissue mobilization (IASTM)

  • Deep message

  • Hand held or mechanical devices

  • Shaped for specific body part 

  • Initial stroke used to find fibrotic issues

  • Decrease adhesions

  • Increase blood blow

  • Help with remodeling

Precaution

  • Causes bruising 

  • Dont press too  hard

  • Warn there could be bruises 


Myofascial release

  • Deep fascia: Surround muscles and other organs

  • Visceral fascia: Covers organs such as the heart and lungs

  • Parietal fascia: Lines the walls of body cavities, such as the abdomen and pelvis

  • MFR works on deep fascia around the muscles

  • “Sloth” message; slow

  • Light touch

  • Wont use sam pressure with traditional message

  • Not deep

  • Maintain pressure til tissue responds

  • Relieves pain

  • Promote circulation

  • Allow mobility of the tissues

  • Calming effect; relaxing


Trigger point release

  • Type for myofacial treatment

  • For myofascial pain syndrome

  • Twitch response- metabolic waste not leaving cells; when put pressure on it, muscle twitches to restore circulation to area; will feel it let go

  • Digital pressure: firm pressure to trigger point using finger, thumb, elbow or massage tool

  • Massage: kneading, stroking, compression to release trigger points

  • Foam rolling; apply pressure and stimulate release

  • Dry needling; thin needles inserted into trigger point to stimulate twitch response and promote release

  • Injection therapy; local anesthetic or corticosteroid into trigger point to block pain and inflammation

  • Uncomfortable

  • 20-30 seconds

  • Breath in through nose and out through mouth

  • Intensity of soreness goes down; can progress to push harder- indicated by the twitch response

  • Encourage pt. To not tighten up

  • Can only apply more pressure you feel twitch response/ rolling

The goal of myofascial trigger point release 

  •  relieve pain 

  • Relieve adaptive shortening 

  • improve joint motion, 

  • improve circulation/ blood flow

  •   eliminate perpetuating factors.

For plantar fasciitis 

  • Butte knife or special tool to calf

  • Feel rumbly bumps that are the contracted muscles

  • Use the tool to create inflammatory response to promote healing

  • Will be red prior 

  • Start easy and then increase pressure

  • Start distal then go to proximal


Fascial unwinding 

  • Putting stretch on the fascia then letting go

  • Hook lying position

  • Hold 30 seconds

  • Create stretch in whole area

  • Then let it unwind

  • Let body part do whatever it wants to do

  • Do not restrict the fascia 

  • If done on head, the head will move away from the pressure

Trigger points- where muscles pick up stress and contract 

  • Cannot be exercised or learn exercises as it is already contracted 

  • Usually get them on both sides

  • Active one- one side you feel

  • Latent one- trigger point you don’t feel

  • Is the tightest spot

Cupping

  • Suction Creation:

  • Cupping therapy involves placing cups (typically made of glass or silicone) on the

  • skin and creating a vacuum within them, either through a fire or a pump.

  • Tissue Lifting and Separation:

  • The suction lifts the skin and superficial muscle layers, which helps to improve

  • blood flow to the treated area.

  • Improved Circulation:

  • Increased blood flow can help deliver nutrients and oxygen to the tissues,

  • promoting healing and reducing pain.

  • Myofascial Release:

  • Cupping can help release tight tissues, improve trigger points, and enhance

  • overall tissue mobility.

  • Types of cupping

  • There are two main types of cupping: dry and wet. Dry cupping does not involve

  • any skin piercing, while wet cupping involves lightly piercing the skin with a

  • needle, allowing blood to flow into the cup.

  • ONLY USE DRY FOR PT

  • Don’t put one on forehead

  • Known to work through pain gate theory 

What makes a massage a good experience?

  • Appropriate pressure

  • Calm environment

  • Draping 

  • Modesty 

  • Comfy room temperature

  • Quiet therapist 

  • Trusted therapist 

To be a good therapist 

  • Ask consent

  • Be aware of cultural differences 

  • Be aware of gender differences

  • Keep pt. Modest 

  • Gain trust 

  • Make as relaxing as possible 

How massage works

  • Mobilizes soft tissues (muscle, fascia, pain nerves ).

  • Pain often originates from soft tissue

Massage definition 

  • Systemic, scientific manipulation of soft tissue

  • Remedial restorative purposes 

  • Influences reflex and mechanical processes for results

  • Effects body systems 

Fascia 

  • Protects muscle- tightening due to injury 

  • Assists muscles in contraction

  • Nociceptors - pain nerves

  • Multidirectional 

Free-up

  • Specific for massage 

  • Only stains khakis

  • Has latex 

How friction works 

  • Keeps scar tissue from sticking 

  • Makes scar lengthen 

Good body mechanics 

  • Lock elbows in

  • Lean with pelvis 

  • Back erect 

  • Raise/lower plinth as needed

  • Weight shifts

Before treatment 

  • Put towel around the face place 

  • Ask if pt. Has latex allergy (In free- up)

  • Take off jewelry (rings, watches, bracelets)

  • Draping for modesty and protecting clothes

  • Offer pt.pillow under the hip bones

Contraindications

  • Congenital heart failure/ Chronic heart failure

    • Massage moves fluid

    • Fluid could move to heart 

    • Cause heart attack

  • Fracture

  • Infection

    • Can spread it 

  • Blood clot

  • Malignancy 

  • Skin diseases 

  • Ring worm

Precaution

  • Latex allergy (Free-up) 


Myofascial trigger point release- tightness in spinal line

  • Limited rotational components in spine

  • Decreased power in legs

  • Look for 

    • Heigh difference in legs

    • Flat hamstrings- good

    • Round gluteus max- good

    • Rounded hamstrings- tightness

    • Flat gluts- tightness

-Arm hand off table (opposite of tight leg)

- hand must be relaxed

-stretch out lat muscle

-Dig in lat muscle group until there is a sore spot 

-prolonged for 20-30 seconds

- Causes ischemia because vasoconstriction

-deep breaths

-let pt. Talk

- doesn’t always feel good

- pt. Must be relaxed to work

-use thumb 

- leg lifts again to compare 


Myofascial release

  • Will feel twitch response

  • Allow any movement to happen as long as it is relaxed

  • Woks if the fascia is sliding your hand without you moving it

Passive release - myofascial 

Active release-  myofascial

  • Respicts muscle

  • Forces fascia relax

  • Maybe leave bruise

Calf release

Calf has 4 compartments

Compartments made of fascia

Compartment syndrome

Trigger points

Poke around on calf and find trigger points

PTA pushes

pt. put foot in dorsiflexion

Clock wise and counter clock wise big circles with foot 


ON EXAM 

Techniques 

  • Use bigger parts of hand as get deeper

  • No finger tips

  • Heel of hand

  • Distal to proximal

  • Shouldn’t cause pain

Effleurage

  • Light, circular strokes

  • Beginning/end of session

  • Improves lymphatic flow

  • Distal → proximal

  • Circulation

  • Palms/ heels of hands

  • Rock forward and back

  • Avoid ends of finder

  • Press and move up

  • Come off with out pressure

  • Repeat

  • Fingers could be closed or open 

  • 3-5 minutes

Petrissage

  • Kneading, rolling 

  • Push skin up with heel of hand

  • Try to grab 

  • “Roll and press”

  • Increases blood flow

  • Reduces edema

  • Breaks adhesions

  • Does not cause pain

  • improving lymphatic return

  • removing metabolic waste.

  • Use pads of fingers

  • Do NOT curl in fingers/ use fingertips

  • Do not grip



Friction

  • Deep, focused pressure

  • Circular/transverse motion

  • Diagonals, up and down, and across 

  • Helps remodel scar tissue

  • Surface of hand grabs skin

  • Not slippy and slidy

  • Loosens the fascia/ scar tissue

Tapotement (Percussion)

  • Rhythmic striking

  • “Karate chop”

  • Can also be done with fists

  • Stimulates circulation and nerves

  • Used in chest PT (airway clearance)

Vibration

  • Rapid shaking/oscillation

  • Promotes relaxation

  • Reduces soreness/stiffness

  • Improves ROM and flexibility

  • Loosens whatever is tight

History of massage 

  • historically uses:

  • reduce pain

  • promote relaxation.

  • first used in the late 1700’s

  • developed in Sweden.

Massage improves: Mechanical effects

  • circulation, 

  • symphatic flow

  • increase ROM