MASSAGE TECHNIQUES

History of Massage
• Natural reaction to when the body hurts is to
rub it
• Dates back to at least the ancient Olympics
• In Europe in the Middle Ages, the Church of
Rome & its religious teachings discouraged
massage as a healing practice
• Sweden – early 19th century, Peter Ling
(acknowledged founder of curative
gymnastics) – appears to be founder of
modern day massage techniques,
incorporated with French massage
techniques
• Massage is derived from 2
sources
– Arabic verb mass “to touch”
– Greek word massein “to
knead”
• Egyptians, Romans, Japanese,
Persians, & Chinese were known
to practice massage therapy
What is Massage Therapy?
• Mechanical modality
• Used to manipulate the body’s tissue
• Effective in promoting local & systemic
relaxation, increasing local blood flow,
breaking down adhesions, & encouraging
venous return
• Act of rubbing, kneading, or stroking the
superficial parts of the body with the
hand or an instrument for the purpose of
modifying nutrition, restoring power of
movement or breaking up adhesions
MASSAGE
• A term use to signify a group of systemic and
scientific manipulations of body tissues that
are best performed with the hands for the
purpose of affecting the nervous system and
muscular system and general circulation
Physiological Effects of Massage Therapy
• Depending on the amount of pressure
applied & the speed of the stroke:
–evokes systemic relaxation
–increase blood flow to the area
• Edema reduction – when performed
properly it can increase venous &
lymphatic flow
• Reduces pain
• Cardiovascular changes – deep friction or
vigorous massage was thought to produce
vascular changes
– decreased heart rate, breathing rate, & b.p.
if the purpose is for inducing system
relaxation
Mechanical Effects
• Techniques that stretch a muscle,
elongate fascia, or mobilize soft-tissue
adhesions or restrictions are all
mechanical techniques
• Mechanical effects are always accompanied by
some reflex effects
– As mechanical stimulus becomes more
effective, reflex stimulus becomes less effective
• Muscle –for mechanical stretching or to relieve
pain associated with trigger points
• Skin – massage has been shown to increase skin
temperature, increase sweating & decrease
resistance to electrical current
• It has been shown to toughen yet soften the skin
• Acts directly on the surface of the skin to remove
dead cells
• Stretches & breaks down fibrous tissue
Psychological Effects
• Reduces patient anxiety, depression, &
mental stress
Types of Massage
• These techniques can be categorized by
geographic region of origin, either classic western
(European) or eastern (Asian) forms of massage.
• The most common western (European)
techniques are those outlined by the Swedish
system.
Western Forms of Massage
These four basic massage strokes are the following as
originally described by the French:
1. Effleurage
2. Petrissage
3. Friction Massage
4. Tapotement
Effleurage
• involves gliding the palms, fingertips, and/or
thumbs over the skin in a rhythmic circular
pattern with varying degrees of pressure.
• performed by maintaining continuous contact
with the skin and stroking from a distal to a
proximal position on the extremities, torso, or
spine
• This technique is often used as a prelude to
more aggressive massage techniques or
manipulation.
• Deeper mechanical stroking can result in
mechanical effects on the circulatory and deep
myofascial systems.
• gliding movement of hands over surface of the skin
a. superficial
b. deep
Pétrissage
• is also known as “kneading massage.”
• It involves both hands compressing the skin
between the thumb and fingers.
• The tissue is grasped from the underlying skeletal
structures, lifted, and massaged.
• Both hands alternate rhythmically in a rolling motion.
• The depth of pétrissage can determine the
mechanical effect.
• Superficial techniques promote relaxation, whereas
deeper techniques increase blood flow, mobilize fluid
and tissue deposits, decrease adhesions, and
increase tissue pliability.
Physiological Effects
• Deep effleurage
– improve flexibility
• Massage is less effective in decreasing muscular
recovery time, but may be effective
• Little reduction in muscle fatigue when
performing between exercise
• Petrissage
– decrease neuromuscular excitability
• Pétrissage is also considered
compression massage, and several
variations exist, including kneading or
picking up, wringing, rolling, or shaking
the tissue.
• “Kneading” involves circular
movements of one hand superimposed
on the other. The finger pads and
thumb compress tissue and distract it
from the deeper underlying structures.
“Picking up” involves four basic steps:
• Compression of the soft tissue against the underlying
structures
• Grasping the soft tissue and compression,
• Release and;
• Repositioning the hands in a more proximal position
to repeat the process.
• “Wringing” resembles picking up, except
that once tissue is grasped, one hand
pushes while the other one pulls, creating a
shearing-type force in the tissue planes.
• “Rolling” involves grabbing a small amount of tissue
between the finger pads and thumb, and rolling the
tissue as if moving a small object under the skin
• “Shaking” is a technique in which the tissue is
grabbed and vigorously shaken between the hands.
The hands are then repositioned along the course of
the muscle being treated.
Tapotement/Percussion massage
• Uses rhythmic alternating contact of varying
pressure between the hands and the body’s soft
tissue
• Various techniques are used to produce this type
of massage, including hacking, clapping, beating,
pounding, and vibration.
“Hacking”
• involves using the ulnar aspect of the hands to
alternately strike the body tissues. These rapid
strokes at 2 to 6 Hz are delivered in a sequential
pattern along the entire region to be treated
“Cupping”
• involves the use of a cupped palm, which is
percussed against the chest wall.
• This technique is frequently used to loosen
secretions in disease processes such as cystic
fibrosis
“Beating”
• involves using a clenched fist to repetitively
pummel the tissue.
• This is a very aggressive type of tapotement and
is not frequently used.
“Tapping”
• Uses the finger pads, typically of the index and
middle fingers, to percuss.
• The finger pads strike the underlying tissue in rapid
succession.
• This technique is frequently used over the sinuses to
loosen secretions.
Friction Massage
• Friction massage is a circular, longitudinal, or
transverse pressure applied by the fingers,
thumb, or hypothenar region of the hand to small
areas.
• Cross-friction massage is perpendicular to the
fibers and was used extensively during the time
of Cyriax
•
• Very little motion occurs at the fingertips overlying
the skin.
• The tissues are massaged from superficial to deep by
increasing the pressure applied.
• The goal of friction massage is to break down
adhesions in scar tissue, loosen ligaments, and
disable trigger points.
Other Western Techniques
1. Tager psychologic integration
2. Alexander
3. Feldenkrais techniques
4. “Rolfing”
5. Myofascial release, Manual lymphatic drainage
(MLD).
Tager Psychologic Integration.
• This treatment method was developed by Milton
Tager, MD, in the 1940s.
• This technique combines the use of gentle hands-
on tissue work and reintegration of movement
through reeducation and relaxation exercises.
• The hands-on work consists of gently rocking,
stretching, or rolling movements to relax and
diminish tension.
• The movement component of the Tager technique is
coined “mentastics,” which is a combination of
mental, psychologic, and gymnastic elements, and
focuses on making movements lighter and easier
Alexander Technique
• F.M. Alexander (1869 to 1955) was a Shakespearean
actor who had recurrent neck and vocal problems.
• After much self-reflection and postural reeducation,
he noted that his vocal problems could be, corrected
by postural reeducation. He developed a series of
techniques for the treatment of chronic neck and low
back pain.
• His approach centers on balance between
head and neck movement “primary
control,” and a state of dynamic postures
and breathing exercises.
Feldenkrais Pattern
• Feldenkrais emphasizes multiple repetitions to
lay down new neuromuscular patterns, and
considers the entire body, even in the simplest
of movements.
Rolfing Structural Integration
• Ida Rolf (1896 to 1979)
• Rolf saw gravity as one of the primary causes of
dysfunction.
• The primary tenet of her structural integration
system was to help clients achieve proper vertical
alignment and efficient movement.
• The typical regimen consists of a series of ten 60-
to 90-minute sessions.
• Superficial massage is performed initially, with
progression to deeper friction massage. This is in
an attempt to stretch fascia and allow muscles to
relax and lengthen.
• The sessions build on one another, and
additional treatments are frequently required
to accommodate for the changes promoted.
• The deep friction massage traditionally
performed with Rolfing techniques can be
painful.
• Newer techniques have been implemented,
which are less painful and less invasive. Other
techniques have been influenced by Rolfing,
including Kellerwork and Aston patterning
-Myofascial Release
-Manual Lymphatic Drainage
Myofascial Release
• The term myofascial release was coined by Robert Ward,
DO, in the 1960s and further developed by John Barnes,
PT.
• This technique is founded on the premise that the body is
encased in connective tissue (i.e., fascia).
• Fascia is the ground substance that interconnects all
bones, muscles, nerves, and other internal organs and
tissues.
• Injury or tension within one area of the fascia can result
in pain and tenderness.
• Practitioners of myofascial release use gentle stretching
and massage to release the fascial tension, and can often
work on areas that seem unrelated to the primary pain or
injury.
• Myofascial release is frequently used to treat chronic
pain and restore normal range of motion
Manual Lymphatic Drainage
• Manual lymphatic drainage (MLD) was developed in
Europe in the 1930s by Danish physiotherapists Estrid
and Emil Vodder as a technique to control
postmastectomy lymphedema.
• gentle and superficially focused massage where lymph is
moved from areas of lymphatic vessel damage to
watershed regions.
• The first part of the treatment involves
massage of the proximal region of the
extremity to be treated.
• This is thought to dilate the watershed lymph
vessels and allows them to accept fluid from
distal areas.
• After proximal areas have been gently
massaged, a more rhythmic massage is
performed from a distal to a proximal part of
the extremity.
• The typical session lasts 45 to 60 minutes
Eastern Forms of Massage
Acupressure
• It has been defined as digital pressure performed in a
circular motion to treat areas that are typically treated
with acupuncture needles and for the same reason.
• Deep pressure is applied to the acupuncture points in a
circular fashion without the use of lubrication.
• can be used for the treatment of nausea and
vomiting associated with chemotherapy, to
decrease postoperative pain, for the
treatment of headaches, and to decrease
temporomandibular joint pain.
Shiatsu
• Shi (meaning finger) atsu (meaning pressure) is
the Japanese type of body work based on
acupuncture.
• This technique was initially practiced by visually
impaired clinicians. Pressure is applied in
particular meridians similar to acupuncture.
Reflexology
• The application of deep circular pressure applied
to specific dysfunctional points on the soles of the
feet.
• Has been used to treat hypertension, stress,
fatigue, and digestive complaints.
GENERAL CONSIDERATION IN APPLICATION OF
MASSAGE
• Place patient in comfortable relaxed position with
treatment plan in gravity eliminated position in
which gravity will assist in venous flow
• Body part exposed and well supported with clothing
restricting circulation
• Begin with superficial strokes. May move to deep
stroking
• Deep stroking maybe followed by kneading. May
alternate between stroking and kneading
• Stroking and kneading may follow friction massage
• All stroking movements are directed distal to
proximal especially for edema
• Complete treatment with stroking, moving from
deep to superficial stroking
• TREATMENT TIME: VARIES WITH CONDITION AND
PATIENT TOLERANCE
INDICATIONS:
• Subacute and chronic pain
• Muscle spasm
• Superficial scar formation
• Edema
• Postural drainage
CONTRAINDICATIONS
• Acute inflammation
• Acute febrile conditions
• Severe atherosclerosis
• Severe varicose veins
• Phlebitis
• Area of recent surgery
• Thrombophlebitis
• Cardiac arrhythmia
• Malignancy
• Hypersensitivity
• Severe RA
• Hemorrhage in area
• Edema secondary to kidney dysfunction
• Heart failure venous insufficiency
 “TO KEEP OUR BODY IN GOOD HEALTH IS A DUTY…
OTHERWISE WE SHALL NOT BE ABLE TO KEEP OUR MIND STRONG AND
CLEAR”

-BUDDHA