Manual therapy 5

Soft-Tissue Technique Dosage: Overview

Effleurage

  • Stroke Pressure

    • Varies from light to moderate to firm.

    • Typically increases throughout the treatment.

  • Duration

    • Guided by swelling reduction.

    • Treatment should continue until swelling reduction is achieved, generally lasting at least 5 minutes.

    • Longer durations may be necessary if moving fluid from more distal areas, such as from the ankle to the groin.

Petrissage

  • Stroke Pressure

    • Similar to effleurage, it varies from light to moderate to firm, increasing over the treatment duration.

  • Duration

    • Driven by identifying improved tissue mobility.

    • Should continue until desired changes are achieved or for up to approximately 5 minutes.

    • Progression to other treatments (e.g., targeted myofascial release or range of motion exercises) should only occur after this time.

Myofascial Release

  • Stroke Pressure

    • Application of firm pressure focused on achieving a strong stretch sensation for the patient.

  • Discomfort Level

    • Mild to moderate discomfort is likely but should remain stable, returning to baseline once the technique is ceased.

  • Segment Movement

    • Can include active or passive movements or may involve a sustained hold at the end range of motion.

  • Dosage Time

    • Typically mirrors joint manual therapy protocols, often involving 3 sets of 45-60 seconds each.

Trigger Point Therapy

  • Pressure/Release Technique

    • Gradually apply increasing thumb pressure until the tissue resistance or barrier is felt (often accompanied by tenderness).

    • Maintain pressure until the therapist detects release in tension or for a duration of 1-2 minutes.

    • Muscle can be in a lengthened position with a gentle (10% effort) isometric contraction maintained.

  • Ischemic Pressure Technique

    • Sustained pressure sufficient to cause blanching of the skin is applied.

    • Constant Approach: This pressure is maintained until decreased tension is achieved or pain relief occurs, generally ceasing after 1 minute.

    • Alternating Approach: Alternate between 5-10 seconds of firm pressure and a 2-3 second release; repeat until pain is reduced or 2 minutes have elapsed.

Contraindications/Precautions

  • Conditions to Avoid

    • Malignancy: Tissue health may be compromised.

    • Systemic or Localized Infection: Risk of spreading the infection or exacerbating the condition.

    • Acute Circulatory Condition: Therapies may worsen circulation issues.

    • Fracture/Risk of Fracture: Treatment could exacerbate the injury.

    • Open Wounds: Risk of infection or delayed healing.

    • Skin Conditions: Certain treatments may irritate the condition.

    • Hematoma: Massage in areas of hematoma can worsen the condition.

    • Active Inflammatory Arthritis: Manipulation may aggravate inflammation.

Cochrane Library Review Summaries

Massage for Low-Back Pain

  • Authors: Furlan AD, Giraldo M, Baskwill A, Irvin E, Imamura M.

  • Conclusions

    • Little confidence exists regarding the effectiveness of massage for low back pain (LBP).

    • Improvements noted in pain outcomes with massage were only short-term for acute, sub-acute, and chronic LBP.

    • Functional improvement observed in sub-acute and chronic LBP compared to inactive controls only for short-term follow-ups.

    • Minor adverse effects associated with massage.

Massage for Mechanical Neck Disorders

  • Authors: Patel KC, Gross A, Graham N, Goldsmith CH, Ezzo J, Morien A, Peloso PMJ.

  • Conclusions

    • No specific practice recommendations due to uncertainty regarding effectiveness.

    • Massage provides immediate or short-term benefits in pain and tenderness as a standalone treatment.

    • Calls for future research to investigate long-term effects and effectiveness of repeated treatments.

References

  1. Furlan AD, et al. Massage for low back pain (review). Cochrane Database Syst Rev. 2015;9:CD001929.

  2. Kietrys DM, et al. Effectiveness of dry needling for upper-quarter myofascial pain: A systematic review and meta-analysis. J Orthop Sports Phys Ther. 2013;43:620-634.

  3. Lavelle ED, Lavelle WF. Myofascial trigger points. In: Smith, HS, eds. Current therapy in pain. 1st ed. Philadelphia: Saunders: 2009: 577-581.

  4. Myers T. Anatomy trains: myofascial meridians for manual and movement therapists. 2nd ed. London: Churchill Livingstone: 2009.

  5. McPartland JM, Simons DG. Myofascial trigger points: translating molecular theory into manual therapy. In: Dommerholt J, Huijbregts P, eds. Myofascial trigger points: pathophysiology and evidence-informed diagnosis and management. Massachusetts: Jones and Bartlett: 2011: 3-15.

  6. Patel KC, et al. Massage for mechanical neck disorders (review). Cochrane Database Syst Rev. 2012;9:CD004871.

  7. Rubinstein SM, et al. Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev. 2012;9:CD008880.

  8. Rubinstein SM, et al. Spinal manipulative therapy for chronic low-back pain. Cochrane Database Syst Rev. 2012;2:CD008112.

  9. Simons DG. Understanding effective treatments of myofascial trigger points. Journal of Bodywork and Movement Therapies. 2002;6:81-88.

  10. Sluka K, Milosavljevic S. Manual therapy. In: Sluka K, eds. Mechanisms and Management of Pain for the Physical Therapist. 2nd ed. Philadelphia: IASP Press; 2016: 237-247.

  11. Travell JG, Simons DG. Myofascial Pain and Dysfunction: The Trigger Point Manual. Baltimore: Williams & Wilkins; 1983.