Transcript Therapeutic massage and myofascial mobilization

Aila Nica J. Bandong, PTRP
Instructor
Department of Physical Therapy
College of Allied Medical Professions
At the end of the lecture, the students should be
able to:
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Discuss therapeutic massage and myofascial mobilization
in terms of
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physiologic mechanism
benefits for use
indications, contraindications and precautions
Discuss the basic techniques of therapeutic massage and
its variants
Enumerate the different techniques of myofascial
mobilization
Cite evidence on the effectiveness of therapeutic
massage and myofascial mobilization in the given
sample cases
Massage is the therapeutic
manipulation of the soft tissues of
the body with a goal of
normalization of those tissues.
Also defined as hand motions
practiced on the surface of a living
body with a therapeutic goal.
mechanical
physiologic
Assist in venous
and lymphatic flow
Metabolism
Stretching of superficial
tissue
Venostasis
Loosen scar tissue
Edema
Mobilize interstitial fluid
 Reduce or modify edema
 Increase blood flow
 Decrease muscle soreness or
stiffness
 Alleviate pain
 Prevent or eliminate adhesions
 Facilitate relaxation
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Relaxation
Pain relief
Reduction of edema
Increase ROM
Metabolically prepare injured or involved
muscles for exercise
Encourage confidence of patient
Evaluate patient’s soft tissues
Prepare healthy muscles for strenuous
sports activity
Assist the body in recovering from the
aftereffects of strenuous activity
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Tense muscles
Scar tissue
Edema
Pain
 Malignancy
 Atrophic
skin
 Thrombi
 Chronic subluxation
 Atherosclerotic
 Pathologic conditions
plaques
that could be spread
along the skin,
 Infections
through the lymph or
 Scars that are not
the blood.
fully healed
 Area where there is
 Patients on antibleeding
coagulants
 Areas of acute
 Calcified soft tissue
inflammation
 Skin grafts
 Phlebitis
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Disorders of circulatory system
Areas with abnormal sensation
Over recent surgery
Joint replacements
Immunocompromised patients
In the presence of medications
that may alter sensation, muscle
tone, standard reflex reactions,
cardiovascular function, kidney
and liver function and personality
 Will
not reduce obesity
 Will not delay loss of muscle
strength
 Will not hasten recovery of sensation
after nerve injury
Western variant
Effleurage or
Stroking massage
Petrissage or
Kneadingg massage
Tapotement or
Percussion massage
Friction or Deep
friction massage
Vibration
Acupressure
Eastern variant
Reflexology and
auriculotherapy
Shiatsu
 Aka
stroking massage
 Therapist’s hands glide across the skin
overlying the muscle being treated
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Superficial effleurage
Deep effleurage
 Promote
relaxation
 Note areas of spasm and tightness
 Get the therapist’s hands from one
problem area to another Accustoms the
patient to the touch of the therapist
 The only technique that may be employed
in instances of extreme soreness
 Deep effleurage will provide a passive
stretch to given muscles or muscle groups
 Knuckling
 Loose
fist
 Single/double hand
 Three-count stroking of the
trapezius
 Horizontal stroking
 Single/double forearm
 Aka
kneading massage
 Strokes that attempt to lift the muscle
mass and wring or squeeze it gently
 Soft tissue is compressed between the
hand or fingers of the therapist and
gently squeezed as the hands move in a
circular motion perpendicular to the
direction of compression
 Applied vertically in relation to the
tissues
Remove
waste products
Assist venous return
Effective in decreasing hypertonicity
Beneficial in mechanically softening
the superficial fascia
Picking- up
 Pinching
 Rolling
 Wringing
 Fulling
 Milking
 Fist kneading
 Digital kneading
 Alternating two-hand petrissage
 Two-finger petrissage
 One-hand petrissage
 Alternate one-hand petrissage
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 Aka
deep friction massage
 Pressure of varying intensities is applied with
the ball of the thumb or fingers
 Mechanical effect is the application of shear
stresses to the underlying tissue specifically
at the interfaces (dermis-fascia, fasciamuscle, muscle-bone, scar tissue-bone)
 Considered as the most
important massage technique
 Generally performed for 30
seconds to 10 minutes
 No lubricant used
Massage
into deep joint spaces or
around bony prominences
Breakdown connective tissue and
scar adhesions except deep fibrositis
in muscle belly
For pain reduction through
mechanism of counterirritation and
hyperstimulation analgesia
Cross-fiber
technique
Storm’s technique
Cyriax’s friction massage
Aka
percussion massage
The skin and muscle are impacted
with repetitive compressive blows
by the hands
Used
when stimulation is desired
Usually performed in athletes
Can be done to prepare patient for
stretching
Used to loosen mucus in the lungs
Hacking
Cupping
Fist
beating
Beating over palm
Slapping
Finger tapping
A
fine tremulous movement made by
the hand or fingers placed firmly
against a part
Can be used better with electrical
vibrator
Follows the path of the nerve in
treatment of peripheral neuritis
Used
for a soothing effect especially
in peripheral neuritis
Can be used to relax antagonist
muscle through reciprocal inhibition
Break up monotony of massage
Can be used to loosen consolidations
in the lungs
Vertical
pressing downward that
penetrate the subcutaneous layer
Can be done using the thumb, heel
of the hand, palm, fist, knuckles,
forearm, elbow
Therapist stays perpendicular with
actual compression (~45 to 90
degrees to the body)
Can
be used to replace effleurage if
gliding strokes can not be performed
Used to tone the muscles
 Stimulates
the muscle spindle
 Relaxes
muscle groups or an entire
limb
 Warms and prepares the body for
deeper bodywork
 Indicated for extremely tight muscles
 Soothing
and rhythmic method used to
calm an individual
 Up-and-down and side-to-die
movement of the body
Massage
forces are applied
using the fingers on
acupuncture points
Localized finger pressure
coupled by circular movements
Pressure is increased until
pressure becomes heavy then
held constant
 All
parts of the body are believed to be
mapped to different point on the foot
(reflexology) or the ear (auriculotherapy)
and massage of a point produces change in
the structure mapped to that point.
 Shi
(finger) and atsu
(pressure
 Japanese form of
acupuncture
 Pressure is applied at
specific points
(meridians)
 Was first administered
by blind clinicians
 Milieu
 Treatment
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variables
Friction-reducing medium
Rhythm
Rate
Pressure
Direction
Area to be treated
Duration
Frequency
Duration of the program
Fascia:
three-dimensional web of
connective tissue running
continuously through the body and
superficial to deep without any
interruption
Three layers:
 Superficial
 Deep
 Dural
Functions
of Fascia:
 Holds
tissues together
 Separates structures to allow mobility
 Protection, nutrition, elimination, and
metabolism
Composition:
 Collagen
 Elastin
 Ground
substance
Fascial Restrictions
 Cause excessive pressures on pain sensitive areas
as well as excessive tensile force on the
neuromusculoskeletal sturctures
 Sets up the environment for poor cellular
efficiency, necrosis, disease, pain , and
dysfunction throughout the body
 Dysfunction along the deepest/dural fascia can
have neurologic effects
 A restriction in one area may cause restrictions in
other areas of the body
 Also
known as trigger point therapy,
myofascial release
 Since fascia has colloidal properties
it can be manipulated and stretched
by sustained by pressure
 Effect is loosening of fascia 
release restrictions or barriers
within the fascial layers  relieve
symptoms and promote normal
quality and quantity of motion
A
whole-body “hands-on” approach to
evaluation and treatment of the human
structure
 Evaluation
of fascial system
 Intervention
 Re-evaluation
 Incorporated
in a comprehensive
program that includes modalities,
therapeutic exercise, muscle energy
techniques, mobilization and
manipulation
 Pain
 Movement
restrictions
 Spasm
 Neurologic
dysfunction
 Sports injuries
 Chronic fatigue syndrome
 Fibromyalgia
 Pediatrics
 Scoliosis
 Menstrual, pelvic, temporomandibular
pain
 Headache
 Malignancy
 Febrile
state
 Acute circulatory condition
 Aneurysm
 Acute rheumatoid arthritis
 Sutures
 Healing fracture
 Osteoporosis or advanced degenerative
changes
 Systemic or localized infection
 Open wounds
 Anticoagulant therapy
 Advanced diabetes
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Cross-hand techniques
Arm or leg pull (unilateral or bilateral)
Cranial base release
Skin rolling
Scar release
J-stroke
Any questions?
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