Lecture(2)
Dr. Rehab F.M. Gwada
Objective of Lecture
To discuss treatment considerations and
guidelines
To identify the preparation of equipment , patient
,and therapist for
applied massage.
To identify different types of massage
manipulation
Contents of the Lecture
Treatment considerations and guidelines.
Preparation for applied massage:
a)Equipment
b) Patient
c) Practitioner
Types of massage manipulation(massage strokes)
Treatment Considerations and
Guidelines
Knowledge of anatomy essential
Understanding of existing pathology
Thorough knowledge of massage principles (must
have manual dexterity, coordination, &
concentration). Must also exhibit patience &
courteousness.
Treatment Considerations
Pressure regulation should be determined by the type
& amount of tissue present. Also, pressure is governed
by the condition & which tissues are affected.
Rhythm must be steady and even.
Duration depends on pathology, size of area, speed of
motion, age, size, & condition of patient.
Massage of back or neck area might take 15-30 min,
while it may require less than 10 min. for a large joints.
Treatment Considerations
If swelling is present in an extremity, treatment should
begin proximally.
“Uncorking the bottle”, “uncorking effect”
Massage should never be painful, except possibly for
friction massage. It should not cause ecchymosis.
Direction of forces should be applied in the direction
of the muscle fibers.
Each session should begin & end with effleurage.
Treatment Considerations
Make sure the patient is warm and in a comfortable,
relaxed position.
The body part may be elevated if necessary.
Massage should begin with superficial stroking.
Each stroke should start at the joint or just below the
joint (unless contraindicated) and finish above the
joint so that strokes overlap.
Pressure should be in line with venous flow followed
by a return stroke without pressure.
Bony prominences & painful joints should be avoided
if possible.
Equipment Set Up
Table:
- Must be firm , padded, easy accessible from both sides,
and its height should be comfortable for the therapist.
Preferred a washable plastic surface to avoid the
infection.
Linens and pillows:
hypoallergenic linens are a common choice to avoid
any potential allergies which Differ in size.
a wide variety of bolsters and support pillows(
circular, tube , and wedge-shaped bolsters )
Lubricant
Equipment Set Up
Lubricant(Massage Media)
.
Used to decrease friction between the patient’s skin and the
clinician’s hand ,It is best to use in hairy, and dry skin, recently
removable cast, and present scar tissue.
Massage can be given without any medium being used.
lubricants may interfere with petrissage (the kneading & lifting )as
well as friction massage.
Should be absorbed slightly by skin but does not make it slippery
Types of lubricants that may be used are olive oil, mineral oil(baby
oil), cocoa butter, hydro lanolin, analgesic creams, alcohol,
powder.
Preparation of the Patient
relaxed and comfortable position
body should be properly aligned
undress the part to be treated only and must be
adequately supported.
using pillows for each position.
* The treatment area should be well heated and
ventilated.
Preparation of the practitioner
Appearance and personal hygiene.
Hands must be clean, warm, dry & soft.
Nails must be short and smooth.
You must be able to fit your hands to the contour
of the area being treated.
Tied back long hair , and kept jewellery to a
minimum.
Avoid constant hyperextension or hyperflexion of
any joints which may lead to hypermobility.
Preparation of the practitioner
Must obtain correct positioning that will allow
for relaxation, prevent fatigue , backache &
permit free movement of arms, hands, & body.
Weight should be evenly distributed on both
feet.
A good position is required to allow for correct
application of pressure and rhythmic strokes
during the procedure.
Body mechanics and stance
Body mechanics are the proper use of postural techniques.
Principles of Body Mechanics
1. Strength: to assist patient on and off the table and performing the
massage.
2. Stamina: to see several patients over the course of a single day.
3. Breathing: to relax and keep a steady pace, and enhance mental and
physical health.
4. Stability: to move from a stable base.. Proper body mechanics will
transfer the force from the lower body to the upper body and then to
the client.
5. Balance: In combination with stability, balance helps therapists
overcome the forces of gravity.
The more balanced a therapist is, the less energy he or she will expend
during the massage.
Body mechanics and stance
Stances
There are two main stances used in the application of
massage therapy:
front/archer
straddle/horse.
Figure
:Performance
of effleurage
stroke in the
front stance.
Bend front
knee to reach
client. Sink
into your front
leg, an let your
hands slide
along the
client.
Figure :
Performing the
return stroke
in the front
stance. Bend
your back
knee and push
off with your
front leg while
returning your
hands along
the client.
Figure :
Performing
the massage
stroke in the
horse stance.
Bend knees to
reach the
client, and
performstroke
keeping the
knees bent
and the low
back straight.
Effleurage
Massage Strokes
Pétrissage
Tapotement
Vibration
Friction (circular, transverse)
Myofascial Release techniques
Various other forms – some may combine stroke
Effleurage
Stroking of the skin
Performed with palm of hand
Stimulates deep tissues
Performed with fingertips
Stimulates sensory nerves
Superficial, rhythmic stroking:
Contours the body or relates to direction of underlying
muscles
Deep stroking:
Follows course of veins & lymph vessels
Effleurage
May be performed slowly for relaxation or rapidly to
encourage blood flow & stimulate the tissues
Performed in rhythmic manner
One hand should always be in contact w/ skin
Light effleurage is performed at beginning & end of
massage or may be used between petrissage strokes
At beginning – relaxes patient & indicates area to be
treated
At end – calms down any irritated areas
Petrissage
Consists of kneading manipulations that press and roll muscles
under fingers or hands
Muscles are gently squeezed, lifted, and relaxed
Hands may remain stationary or move along length of muscle or
limb
Often performed without lotion
Performed from the distal to proximal portion of the muscle.
Increase venous and lymphatic return and press metabolic
waste products out of affected areas.
Can also break up adhesions between skin and underlying tissue
Tapotement
Uses a variety of percussive or beating techniques.
Increase circulation and blood flow.
Stimulate peripheral nerve endings.
Desensitization of irritated nerve endings.
Promotes relaxation
Tapotment
(Percussion)
Hacking
Tapotment
(Percussion)
Hacking
Slapping
Tapotment
(Percussion)
Hacking
Slapping
Beating
Tapotment
(Percussion)
Hacking
Slapping
Beating
Tapping
Tapotment
(Percussion)
Hacking
Slapping
Beating
Tapping
Clapping or cupping
Vibration
A fine tremulous
movement, made by hand
or fingers placed firmly
against a part causing a
part to vibrate
Hands should remain in
contact and a rhythmical
trembling movement will
come from arms
Friction massage
Deep pressure technique.
Circular:
Use a circular motion with thumbs,
elbow, or a commercial device
Effective in treating muscle spasm &
trigger pts.
Friction Massage
Transverse
The thumbs or fingertips stroke in opposite directions
Reaches deep tissues
Begin lightly and then move to firmer strokes
Muscle should be placed in relaxed position
Should be avoided in acute conditions
Effective in chronic tendonitis or other joint adhesions
Purpose is to increase inflammatory response to progress healing
process .
Lasts for7 to 10 minutes every other day
Myofascial Release
Use the technique to ease pressure in the fibrous bands of connective
tissue, or fascia, that encase muscles throughout the body.
When muscle fibers are injured, the fibers and the fascia which
surrounds it become short and tight .Myofascial release is a technique
that focuses on stretching, broadening and/or loosening the connective
tissue.
This helps the athlete regain or maintain normal ROM
reducing abnormal adhesion between connective tissue
regain or maintain normal ROM.
How to Apply Myofascial Release
Myofascial techniques are more effective when applied
without a lubricant
Use moderate to light pressure on the tissue
and stretch it to the point of resistance.
pulling of tissues in opposite directions, stabilizing the
proximal/superior position w/ one hand while applying a
stretch w/ opposite hand
Acupressure
Type of message that is based on the Chinese art of
acupuncture.
The Chinese believed in forces (-ve and+ve through the
body) that controls all aspects of life. Disease results
from some imbalance between these two forces.
The lines that these forces followed are called
meridians
There are 14 meridians.
Acupressure
Along the meridians are
acupuncture points Lung (L)
The Chinese have identified Large Intestine (LI)
thousands of acupuncture Stomach (ST)
points Spleen (SP)
Reference to these charts and
Heart (H)
stimulation of those points Small Intestine (SI)
can reduce pain in areas of the
Urinary bladder (UB)
body associated with the
Kidney (K)
Pericardium (P)
particular point.
Triple warmet (TW)
Gall bladder (GB)
Liver (LIV)
Governing vessel (VB)*
Conception vessel (CV)*
Myofascial Trigger Points
Trigger points are the counterpart of acupuncture points
May be found in muscle, tendons, myofascia, ligaments
& capsules surrounding joints, in periosteum, & in the
skin
May activate & become painful due to trauma
Stimulation of these points have resulted in pain relief
Techniques
Location of points:
Use an ohmmeter to differentiate the electrical
impedance of areas
OR palpate the area until either a small fibrous nodule or
strip of tense muscle tissue that is tender to the touch is
felt.
Use the thumb, index or
middle fingers or elbow to do small
friction- like circular
motions
Amount of pressure applied
should be intense and painful
Patient reports a dulling or numbing effect
Treatment times range from 1-5 min at a single points
Thank you
