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Massage as a Modality

Form of manual therapy utilized to bring about physical, physiological, and sometimes psychological changes.

PTs/ATs traditionally perform therapeutic massage versus recreational massage.



Therapuetic Vs. Recreational

Reactional - The use of a variety of manual techniques designed to relieve stress, promote relaxation and general wellnessin a person who has no definable health problem.

Therapuetic - use of a variety of manual techniques designed to promote stress relief and relaxation, mobilize various structures, relieve pain and swelling, prevent deformity and promote functional independence in a person who has a specific health problem.


Why Massage?

  1. Foundation for principles of touch and palpation
  2. Foundation for principles of draping and client handling
  3. Gateway modality
  4. Effective intervention


General Effects of Massage on Cardiovascular System

Circulation - Dilation of superficial vessels via local reflexes. Increase in Stroke Volume via promotion of venous return. Decrease incidence of DVT via decrease in blood viscosity and hematocrite.

Edema - Increases lymph flow via mechanical pressure.


General Effects of Massage on Connective Tissue

Decreases pain and improves tissue mobility

Cyriax Friction -

Traumatic hyperemia

Prevents/Disrupts adhesions

Temporary analgesia


Traumatic Hyperemia

Traumatize Connective Tissue



Temporary Analgesia

Temporary Numbing


General Effects of Massage on Muscle Tissue

Decrease muscle spasm

Decreases muscle hypertension


General Effects of Massage on Nervous System

Decreases pain, possibly via the Gate Theory of Pain and via an increase an opiate production.


Clinical Indications for Massage



Muscle Spasms

Trigger Points

Insufficiencies of Circulation

Contracted Tissue

Specific or General Tension


Contraindications for Massage

*contraindications may be absolute or relative in this course*

Severe Distress (severe pain, febrile state)

Systemic Edema

Acute Conditions (0-48hrs)

Over recent Surgery

Increased circulation is not desired

Contagious skin condition

Over foreign bodies or sharp bony prominences

Over areas of active bone growth (fracture healing)

Over areas of decreased sensation

Tuberculosis Diagnosis

Ovr pregnant Abdomen


Considerations before Massage

Is massage indicated

Is massag contraindicated

Is the patient Agreeable

How are you going to proceed (technique, position,drape,duration)


Role of Touch

Interaction is both physical and psychological

Helps you to identify the patient's state

Touch can communicate your state of being



Positioning of Patient

Support given to natural joint curvatures

Limbs should be elevateds to allow gravity to assist (when possible) with circulation.

Patient should not be holding/supporting any part of themselves

above all else, the patient should be comfortable.



Table Height


Is usually between therapists wrist and fingers



Basic Massage Stokes

  • Effleurage - Rythmic, Consistant, Stroking
    • Superficial - reflex effect, calming
    • Deep - reflex and mechanical effect
  • Petrissage and Compression - intermittant kneadin
    • May be unilateral, bilateral, or digital
  • Friction - Sustained pressure with movement
    • May be linear, cross fiber, circular
    • Cyriax Cross fiber is a Particular technique



Rythmic shaking of tissue or limb



Percussion/ Tapotement

Hacking - judi chop

Monkey punch - gorilla hammer

Cuping - with the hands

Slapping - with open hands


Direct Pressure

sustained pressure without movement


Trigger Point Technique

Compression and stretch technique to relieve both acute and metabolic issues with TrP