thera peu tic

mass a ge
L un gs o d ng M aynila
Pamantasan ng
llege of Ph ysica l Th erapy
Co
TOPIC OUTLINE
Definition
Brief history
General principles for massage

application
Rationale for the use of massage
Indications & contraindications
Different massage strokes & variations
MASSAGE
Derived from:
Greek word 'massein' - 'to

knead'
Arabic word 'mass' - 'to

touch/to press'
Egyptians, Romans, Japanese,

Persians, & Chinese were known

to practice massage therapy.

MASSAGE
“A group of procedures which are usually done with

the hands, such as friction, kneading, rolling, and

percussion of the external tissues of the body in a

variety of ways, either with a curative, palliative, or

objective point of view” (Graham, 1884)

A certain manipulation of soft tissues of the body

which are most effectively performed with the hands

(Gertrude Beard )
 BRIEF HISTORY
Priest – rubbing and anointing

played a part in the rituals of

Kleen (Sweden) – published a

priesthood handbook of massage (this was

the first scientific written

Hippocrates – advocated gentle

composition about massage)
rubbing for painful joints

Peter Ling (Sweden) –

Albert Hoffa (Germany) –

standardized the terminology of

published a book entitled

massage and define its terms,

“Technic der Massage,” Pioneer of

credited with originating the

five fundamental massage

Swedish system of massage strokes

general principles
BASIC REQUIREMENTS:
Ethical issues as patient privacy.
Understanding of the underlying pathology.
Understanding of basic principles of massage

(manual dexterity, coordination, & concentration).

Also, P.T. must exhibit professionalism, patience &

courteousness.
Hand preparation - Hands must be clean, warm,

dry & soft. Nails must be short and smooth.

general principles
Massage should begin with superficial stroking.

Each stroke should start just below the joint and

finish above it so that strokes overlap.

Pressure should be in line with venous flow.
Bony prominences & painful joints should be

avoided if possible.
Combine massage with movement.
general principles
Massage media:
It is used to decrease friction between patient’s

skin and clinician’s hand e.g. lotions, oil, powder

or analgesic balms.
More medium should be used on hairy areas.
Massage can be given without any medium as

during petrissage, lubricants interfere with the

kneading & lifting. Also, during friction massage,

lubricants may interfere with the desired results.

general principles
Advantages of OIL:
Soft, smooth and slippery
Stimulates hair growth
Prevents pulling of the hair

Advantages of POWDER:
Not messy; prevents moisture
Suitable for general massage; deep kneading

possible
general procedures
PT Position:
P.T. must assume good posture to prevent fatigue

& backache.
Weight should be evenly distributed on both feet.
He must be able to fit hands to the contour of the

area being treated.

A good position is required to allow correct

application of pressure and rhythmic strokes.

general procedures
Depth of pressure:
It is the amount of force a stroke applies to the

tissue.
It depends on the desired result. It should be

increased gradually and with great care

depending on patient’s tolerance.

Direction of forces should be applied in the

direction of the muscle fibers.

Each session should begin & end with effleurage.
general procedures
Speed:
It is how fast or slow a stroke is performed

depending on the desired response, relaxation or

stimulation.

Rhythm:
It is referred to the overall tone of the massage or

the regularity with which a stroke is applied.

general procedures
Duration:
It is the length of time each stroke lasts during its

application or the length of time the stroke

remains on any given body part.

Direction:
It is the pathway of the stroke. On the extremities,

the direction is toward the heart. .

general procedures
Frequency:
It is the number of times each stroke is
performed.
EFFECTS
Types of responses:
Mechanical - as a result of pressure and movement as

the soft tissues are manipulated

Reflex - in which the nerves respond to stimulation

Physiological Effects:
Light, slow strokes - evoke systemic relaxation
Fast, deep strokes - increase blood flow to the area
EFFECTS
Therapeutic Effects:
Improvement of circulation
Increase of warmth of the skin
Rapid elimination of waste
Dissolution of tissue adhesions
Reduction of swelling & indurations of tissues
Loosening and stretching of contracted tendons
Soothing of CNS and peripheral nerves
integumentary system

1. Improvement of nutritive status of the skin.

2. Massage on the skin makes it softer and finer.
3. Mechanically loosen the adherent tissues and

soften the scar.

 musculoskeletal

system
1. Improves muscle length
2. Prevents spasm
3. Obtains relaxation induced by slow superficial

stroking of skin
4. Obtains stimulation through quick brisk strokes,

causing muscle contraction

5. Increases extensibility of the connective tissues
 cardiovascular

system
1. Vigorous massage improves circulation by

increasing venous return. No increase in cardiac

output, BP or arterial blood flow.

2. Decreased HR & BP are obtained if the purpose is

relaxation.
3. Removal of metabolites and overcoming venous

stasis.
 cardiovascular

system

4. Increased capillary dilatation.

5. Stimulation of cell metabolism.
6. Resolution of chronic edema and hematoma
respiratory system

Massage can loosen adherent

mucous from the bronchial

tree and improve respiration,

 pain
Massage can reduce pain by:
Decreasing pressure from swelling or edema

(mechanical pain).
Relieving muscle spasm.
Increasing blood flow & encouraging waste

products removal (chemical pain).

Activating sensory nerves that inhibit pain.
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.
Muscle – massage is done either for mechanical

stretching or to relieve pain associated with trigger

points.
mechanical effects

Skin massage increases skin temperature, increase

sweating & decrease resistance to electrical current.

It also softens the skin.
It removes dead cells present on the skin surface.
It stretches & breaks down fibrous tissues.
indications
Muscle tightness
Scar tissue/adhesions
Subacute muscle strain
Chronic edema
Pain
Respiratory problems
Headache
Varicose ulcers
Insomnia and psychoneuroses [light stroke effleurage]
Painful neuromas and post herpetic neuralgia [percussion]
Before/after game among athletes
contraindications
Elevated temperature
Active Infections - skin diseases, malignancies
Abdominal massage in pregnancy
Thrombophlebitis
Fracture sites
Areas of recent trauma or bleeding
DVT & atherosclerotic plaques
precautions

Debilitated patients
Sensitive and previously burned skin
Too young or too old patients
 mass a ge
strok e s &

variat io ns
 Other types:
Hoffa / Mennel /
Accupressure
Swedish System Shiatsu
Effleurage Reflexology
Petrissage Rolfing
Friction Massage Bindegewebe

Tapotement massage
MacMillan
Effleurage
Stroking of the skin:
When performed with palm of hand, it stimulates deep

tissues.
When performed with fingertips, it stimulates sensory

nerves.

In superficial, rhythmic stroking, the hands contour the body

or relates to direction of underlying muscles.

In deep stroking, the hands follow course of veins & lymph

vessels.
Effleurage
It may be performed slowly for relaxation or rapidly to

encourage blood flow & stimulate the tissues.

One hand should always be in contact with skin.
Light effleurage is performed at beginning & end of

massage or may be used between petrissage strokes.

At beginning – relaxes the body area to be treated.
At end – calms down any irritated areas.
petrissage
Petrissage is also referred to milking or wringing.
It is lifting & kneading of skin, subcutaneous tissue &

muscles.
Performed with fingers or hand & often without lotion.
Skin is gently lifted between thumb & fingers or fingers &

palm & gently rolled & kneaded in the hand.

The stroke is perhaps the hardest stroke since it involves

the use of the “C” part of the hand (between the thumb

and first finger, or the “webbing” as a primary pressure

point.
petrissage
It frees adhesions by stretching & separating the muscle

fiber, fascia, & scar tissue while assisting venous return &

milking out waste products.

Petrissage always follows effleurage to further warm the

muscle tissue.
friction
The goal is to mobilize muscle, tendon, scar tissue &

separate adhesions that restrict movement & cause pain.

Types:
Circular
Applied with thumbs working in circular motion
Effective in treating muscle spasm & trigger points
friction
Transverse:
Applied with thumbs or fingertips stroking the

tissue from opposite directions.

It reaches the deep tissues.
Begins lightly and then move to firmer strokes.
Muscles should be placed in relaxed position
Should be avoided in acute conditions.
Effective in tendonitis or adhesions.
tapotement
Gentle tapping or pounding of the skin. It is a percussion

stroke with the blow being immediately pulled off the

muscle as soon as the hand strikes.

Types of tapotement:
1. Hacking - performed using the ulnar side of the hands

(little finger side) in alternating blows with the wrists kept

loose.
tapotement
2. Beating - performed
3. Cupping - performed

with the ulnar side of

with the palmar side of

the hand and loose

the hand in concave

fists. position.
tapotement
4. Slapping - performed

with the palmar side of the

hand with usually more

finger surface than palm. 5. Tapping (as beating)

and pinching are both

performed using the

fingertips.
tapotement
Physiologic Effects:
It stimulates initially but can become sedating with

prolonged use. In this case, tapotements promote

relaxation, desensitize irritated nerve endings, and break

up congestion in the lung.

vibration & shaking
Vibration - a fine, gentle trembling movement of the

tissues which is performed by hand or fingers.

Shaking - a large movement performed more vigorously.

Technique:
The palmar surface of the hand is placed on the body

part. The movement may either be gentle, in which case

it is known as 'vibration', or vigorous, which is referred to

as 'shaking'. Gentle vibration can be performed using just

the fingertips along course of a nerve.

vibration & shaking
Benefits:
Vibration along the course of a nerve is helpful for restoring and
maintaining the functions of a nerve and the muscles supplied by
them. It is particularly useful in cases of paralysis or weakness.
Gentle vibration also can decrease muscles hypertonicity in the
neurological disorders.
Vibrating and shaking can be performed on the abdominal area to
aid digestion. It can be used to promote tone in the colon and to
relieve constipation.
Vibration and shaking over the thoracic area and chest is
particularly beneficial for respiratory problems, sometimes in
combination with the tapotement movements.