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