Massage

Original Editor - The Open Physio project.

Top Contributors - Lucinda hampton, Rachael Lowe, Naomi O'Reilly, Lauren Lopez and Kim Jackson  

Introduction

Massage image.jpg

Massage is the place were physiotherapy started. There is also evidence of massage being used in many ancient cultures. Massage is an age old technique uses both stretching and pressure in a rhythmic fashion. [1]

Preparation

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

Massage techniques commonly employed include

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[1]

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)

[2]

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.[1]

Percussion/Tapotement Manipulations

[3]

Includes hacking, clapping, beating, pounding or vibrations.

Myofascial Release

Myofascial release is manual technique for stretching the fascia aiming to release fascia restrictions.. Fascia is located between the skin and the underlying structure of muscle and bone, and connects the muscles, organs, and skeletal structures in our body. Fascia can become restricted through injuries, stress, trauma, and poor posture.[4]

Trigger Point Therapy

Trigger point therapy involves the applying of pressure to tender muscle tissue in order to relieve pain and dysfunction in other parts of the body. Trigger points are active centres of muscular hyperactivity, which often cross-over with acupuncture points. The video below shows how a client can do self trigger point massage using a small ball.

[5]

Deep Transverse Frictions

Transverse frictions are a transverse connective tissue therapy applied directly by the fingers. Oscillating pressure is applied across the direction of the tissue fibres. Mainly used on tendon or ligament injuries to help break down thickened, pain-producing scar tissue. I

[6]

Compression Massage

Rhythmic compression into muscles used to create a deep hyperaemia and softening effect in the tissues. Often used for sports massage as a warm-up for deeper, more specific massage work.

Cross-Fibre Massage

Cross-fibre friction techniques applied in a general manner to create a stretching and broadening effect in large muscle groups; or on site-specific muscle and connective tissue, deep transverse friction applied to reduce adhesions and to help create strong, flexible repair during the healing process.

Swedish Massage

Swedish massage techniques includes long strokes, kneading, friction, tapping, percussion, vibration, effleurage, and shaking motions.

The sequence of used is generally

Effleurage: Gliding strokes with the palms, thumbs and/or fingertips

Petrissage: Kneading movements with the hands, thumbs and/or fingers

Friction: Circular pressures with the palms of hands, thumbs and/or fingers

Vibration: Oscillatory movements that shake or vibrate the body

Percussion: Brisk hacking or tapping

Passive and active movements: Bending and stretching[4]

Contraindications

Include: Any type of skin infection; Open wounds; Circulatory problems such as thrombosis, bleeding disorders; Less than 48 hours after injury; during acute inflammation; Tumours if in the area being massaged.[1]

Is Massage Effective?

While often preliminary or conflicting, there is scientific evidence that massage may help with pain and may improve quality of life for people with depression, cancer, and HIV/AIDS.

Pain- A 2008 research review and 2011 NCCIH-funded clinical trial concluded that massage may be useful for chronic low-back pain. Similarly a 2009 clinical trial reported massage may help with chronic neck pain. A 2013 sytematic review of sytematic reviews found that there is an emerging body of evidence supporting the effectiveness of massage therapy for the treatment of non-specific low back pain in the short term. They also cautioned that this should be interpreted with caution as there were methodological flaws in the primary research.[7] Massage may help with pain due to osteoarthritis of the knee, according to a 2012 NCCIH-funded study

Depression- A 2010 meta-analysis of 17 clinical trials concluded that massage therapy may help to reduce depression and a 2010 review concluded that massage may help older people relax.

Cancer- For cancer patients research reviews and clinical studies have suggested that at least for the short term, massage therapy may reduce pain, promote relaxation, and boost mood. However specific precautions with cancer patients are needed Avoid massaging: open wounds, tumour site, blood clot in vein, sensitised areas post radiotherapy.[8]

[9]

References

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  1. 1.0 1.1 1.2 1.3 Stuart Porter. Tidy's Physiotherapy. 15th edition. Edinburg. Elsevier. 2013
  2. Hand on training massage school. Petrissage. Available from: https://www.youtube.com/watch?v=Pa6R8WcBHBU (last accessed 10.5.2019)
  3. Hands on training massage school. Topotement. Available from: https://www.youtube.com/watch?v=EFbVKdFmD10&app=desktop (last accessed 10.5.2019)
  4. 4.0 4.1 Physioworks. What are the common massage therapy techniques. Available from: https://physioworks.com.au/FAQRetrieve.aspx?ID=40342 (last accessed 9.5.2019)
  5. Michiel Akkerman. Trigger point explained with animation. Available from: https://www.youtube.com/watch?v=sltGyJvbvWw (last accessed 10.5.2019)
  6. Bob and Brad. An effective treatment for tennis elbow. Available from: https://www.youtube.com/watch?v=Csb91xr0x00&app=desktop (last accessed 9.5.2019)
  7. Kumar S, Beaton K, Hughes T. The effectiveness of massage therapy for the treatment of nonspecific low back pain: a systematic review of systematic reviews. International journal of general medicine. 2013;6:733. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3772691/ (last accessed 10.5.2019)
  8. NIH Massage therapy for health purposes. Available from: https://nccih.nih.gov/health/massage/massageintroduction.htm (last accessed 9.5.2019)
  9. Lee Health Massage therapy for cancer patients. Available from: https://www.youtube.com/watch?v=hKq9bC4-8MI&app=desktop (last accessed 9.5.2019)