1. Massage Review Casey Christy, MA, ATC, CSCS

2. The Oldest Modality? Practiced in may cultures with many variations Practiced by Hippocrates

3. Massage Benefits Systemic relaxation or invigoration Capillary and arteriole vasodilation (increased blood flow) Increased tissue temperature Breaking up adhesions Encouraging venous return Decreased pain via gate theory, endogenous opiates release

4. Massage Myths “Massage removes lactic acid.” “Massage improves recovery.” “Massage reduces fatigue.” “Massage increases stride frequency/length in runners.” All of the above statements are false.

5. Massage Myths The following effects have also been questioned but are considered massage benefits for the purposes of our class: Muscle temperature increase Blood flow increase (some research says it increases skin blood flow but not arterial flow) Endorphin release

6. Therapeutic Massage vs Rubdown Therapeutic massage is administered by sports medicine professionals. A rubdown is used for relaxation, not necessarily for therapeutic intervention.

7. Therapeutic Massage vs Rubdown Therapeutic massage is “required”…it’s part of the treatment plan for an injury. A rubdown is “desired”…an individual wants a rubdown to relax muscles worked during activity. Clinicians should consider if massage is justified for treatment, the potential for athlete abuse, and if it’s appropriate depending on the setting.

8. Technique Types Effleurrage Petrissage Tapotement Friction

9. Effleurage Stroking of the skin using the finger pads, palms of hands (superficial stimulation) or knuckles (deeper stimulation). Use deep stroking techniques to elongate muscle and to stretch fascia. The shingling technique involves longitudinal, alternating strokes using the left and right palms, following the course of a muscle from distal to proximal. You should always start and end with effleurage.

10. Petrissage Lifting, kneading and rolling of skin. It separates muscle fibers and fascia, frees scar tissue, rids waste products, increases venous return and facilitates relaxation.

11. Tapotement Gentle tapping or pounding, “hacking,” or “cupping.” Tapotement can relax or invigorate (depending on technique used). It also desensitizes irritated nerve endings. Keep your fingers and wrist limp while performing tapotement, especially hacking. Pincement involves repetitive light “squeezing.” Tapping involves “raindrops” applied with your fingers, similar to typing on a keyboard.

12. Friction Two types are commonly practiced: circular and cross-friction. Use your thumbs for circular, it’s effective for muscle spasm and trigger points. Use transverse friction massage to breakdown scar tissue, to ease trigger points, for tendonitis, joint adhesions, etc. It’s applied in a back and forth motion and can be painful.

13. Friction To increase patient comfort, apply moist heat before treatment and make sure the muscle/tendon is in a relaxed position when applying friction massage. Instruct the patient to stretch after treatment and then apply ice if necessary.

14. Friction Knight and Draper describe friction massage as a way of “rebooting the body’s healing computer,” helping restart the inflammatory process which ultimately moves the body towards healing.

15. Massage Principles Always keep one hand in contact with patient. Lotion can be used but is not required. Warm lotion in hand before use; do not pour it on the patient. Use as little lotion as possible. Lotion should not be used with friction massage.

16. Massage Principles Proper body mechanics, posture and position important for the clinician to avoid fatigue or injury. Be aware of massage “negatives” discussed in lab. Consider any contraindications including but not limited to: acute injuries, skin lesions, fracture, hypersensitivity to touch, those with arteriosclerosis, embolism or pain of unknown origin.

17. Apply light effleurage for several minutes. Apply shingling briefly. Apply petrissage for several minutes. Apply various superficial and deep myofascial release techniquessuch as crosshand, distal to proximal mobilization etc. as discussed in lab (and covered in additional powerpoint found on blackboard). Apply light tapotement(ie: light pounding) briefly. Apply petrissage again several minutes. Apply effleurage again for several minutes Sample Massage Sequence

18. References Denegar et al, Therapeutic Modalities for Musculoskeletal Injuries, 3rd edition Knight and Draper, Therapeutic Modalities: The Art and Science Starkey, Therapeutic Modalities, 3rd edition