Massage

Original Editor - The Open Physio project.

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Principles of Massage

Basic Theory

Massage uses pressure to direct venous and lymphatic flow back towards the heart. It is therefore important that the movement is always in this direction so that there is no undue pressure on the closed valves in the veins. These valves prevent backflow of blood by only allowing blood to move in one direction (i.e. toward the heart). As the pressure from the heart pumping subsides and the blood moves back, the valves close and prevent any further back flow.

Massage may also be used to stretch muscle fibres. In this case, the direction is not as important as the strokes are much shorter and therefore pressure in the wrong direction is not significant enough to cause damage.

Posture

Your ability to administer a good massage will depend largely on your own comfort, therefore maintaining a good posture is beneficial to both you and your client. The following are only basic guidelines and it may be that because of the environment you're in, adjustments may need to be made.

  • Work with your back as straight as possible. By flexing your hips and knees, you will be able to move more efficiently and with less stress on your back.
  • Foot position is also important and should be such that you can move in an antero-posterior direction without placing undue strain on your back.

Hand Position

  • The most useful areas of the hand to use are the ulnar border and base of the thumb.
  • Other important areas are the palm and the palmar surfaces of the fingers and thumbs. They provide sensory feedback, thus allowing you to adapt your massage with regard to timing and pressure according to the nature of the tissue. It is for this reason that the use of elbows and knuckles should be avoided.
  • Keep your arms and hands relaxed while massaging, with the hands conforming to the contours of the body.
  • Always pour the oil onto your own hands, never directly onto the client.
  • Try to warm the oil (and your hands) before applying to the naked skin. If this is not possible, at least warn the client of what is to come.

Physical Contact

  • Try to always maintain contact with your client. This allows them to relax, especially if they are lying face down. Removal of the hands may also be interpreted as an indication that the session is over and so cause unwanted movement.
  • If for some reason you must break contact, for example at a sports meeting where situations are not ideal, then make sure you cover the client and do not leave them exposed.


Massage Techniques

Effleurage (Stroking)

The hands are passed rhythmically and continuously over a client's skin, in one direction only, with the aim of increasing blood flow in that direction, stretching tissues, relaxing the client and aiding the dispersal of waste products. The word effleurage is derived from French, meaning "to skim". It involves stroking movements of the hands sliding over the skin and is always the first and last technique (as well as being used between other techniques) applied in a massage session. Effleurage may be used with varying tempo and pressure according to the stage of the condition and whatever the desired effect of the massage is.

Performing Effleurage

You should use a wide surface area of the palmar surfaces of the hands and fingers, either with both hands simultaneously or by alternating hands. Pressure is sustained throughout the stroke and is always toward the heart to encourage venous return. On the return stroke, the hands should maintain light contact and avoid the same path taken by the upward stroke. The position, speed and direction of the movements will vary depending on aim of technique and the part of the body being massaged. For example, long, stroking movements may be used on the legs and arms, while a more circular motion may be preferred for the back and neck.

Effleurage should be carried out in a smooth, rhythmical and relaxed manner, beginning with light touch at the start of the session. This should build up to deeper pressure with slower movements for increased circulation and stretching of the tissues at a later stage in the session. The hands should be relaxed and should follow the natural contours of the client's body. The technique should not be rushed, as you need time and quality of movement to determine any tissue abnormalities that require attention. Quick movements will not allow the client to relax and will certainly be more painful if any areas are tender.

When passing your hands over any bony prominences, pressure should be eased, both since there is no therapeutic value of massaging over bone, and to reduce discomfort felt by the client. To complete any massage, use effleurage to relax the client, especially if intense/painful techniques have been used during the session.

Aims of Effleurage

  • Introduce touch to the client
  • Put the client at ease
  • Warm the superficial tissues
  • Relax the muscles
  • Allow you to palpate and sense the condition of the tissue
  • Stimulate the peripheral nerves
  • Increase blood and lymph flow, thus aiding in the removal of waste products
  • Stretch tissues
  • Relax the client before the end of the session

Not all of these aims may necessarily be accomplished in one session. Much depends on what the requirements of the client are. Lighter, brisk movements may be indicated is the client is about to participate in sport and needs to be stimulated and energized. The same techniques applies more slowly will be better employed after exercise to relax the client and aid in the removal of waste products.

It is very important to achieve your aims using effleurage before moving onto other techniques, such as petrissage. If the muscles have not relaxed sufficiently, deep tissue massage may be uncomfortable and painful. The more pliable the superficial tissue is after effleurage, the more beneficial the deeper massage will be.


Petrissage (Kneading)

The skin is lifted up, pressed down and squeezed, pinched and rolled. Alternate squeezing and relaxation of the tissues stimulates the local circulation and may have a pain-relieving effect with some muscular disorders. Petrissage is derived from a French word, meaning "to knead". The basic movement is to compress, pick up and then release the soft tissues. It is generally used when a deeper effect than effleurage is desired, and it's techniques include:

  • Squeezing
  • Picking up
  • Shaking
  • Rolling
  • Wringing

Performing Petrissage

As with effleurage, pressure is directed toward the heart to encourage venous return. Your hands remain in almost static contact with the client's skin, while moving them over the underlying muscle. The difference is that with petrissage the overall direction is from proximal to distal, as opposed to effleurage, in which the direction of the overall technique is from distal to proximal. This is achieved by first applying shorter strokes toward the heart, but then moving the hands distally before beginning the stroke again. This is supposed to force blood out of an area by the application of pressure, then releasing the pressure and repeating the technique distally to force fresh blood and nutrients into the area.

Recent Related Research (from Pubmed)

References

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