Massage

Question 1

What is the rationale behind using this treatment (Pain/Increase ROM/Strengthen etc)?

Answer 1

reduce pain

muscle relaxation

stimulate circulation

Question 2

What are the physiological effects of the treatment?

Answer 2

muscle relaxation by increasing blood flow

pain relief by stimulating the release of endorphins

improved circulation by promoting vasodilation

stimulate lymphatic drainage, especially through effleurage and through stimulating the lymphatic system

Question 3

What structures are affected by the technique?

Answer 3

skin-increasing circulation to skin

muscles, ligaments and tendons (increase in o2 delivery)

CV system-in aiding venous flow

Question 4

What principles are used in carrying out the technique?

Answer 4

use talcom powder, but not directly on the clients leg, instead on your hand

Question 5

Precautions and contraindications?

Answer 5

cuts or open wounds

cancer

blood clots

broken bones

uncontrolled hypertension (as massage increases blood flow)

fever (massage increase circulation that can increase the severity)

Question 6

How to prepare the room for massage?

Answer 6

wash hands

find talc

make sure brakes are on plinth

adjust bed height to suit you and the patient

make sure space is clear (shoes and socks out the way)

wash, dry and clean plinth at the end of the session

Question 7

How to carry out effluerage?

Answer 7

rub it in and then perform stroking with both hands looking for abnormalities

put hands together, create a V, starting at the bottom and working way upwards towards lymph node and give a gentle squeeze at the end

then change the hand so the pisiform is doing the work, with fingers facing outwards, starting at bottom and up into node

then flat hand, one hand on top the other, leading with fingers, least pressure

Question 8

How to prepare the client for lower limb massage?

Answer 8

lying position to make sure there is no bend at top of leg, to make sure no vessels impeded

patient cant see what’s on, so keep telling them what you are doing

knee bent slightly over pillow so no hyperextension

heel needs to either be off the plinth or have a towel underneath

drape the model to protect the modesty but can still access lymph nodes

raise the plinth so back can be straight and instead use knees to move

if the massage is for an increase in circulation of a reduce in swelling you may want gravity to help, so could face backwards of the plinth and elevate legs with head rest

Question 9

How to prepare a patient for upper limb massage?

Answer 9

draped with a pillow under the arm, increase more pillows to allow gravity to help

can also be sitting with the arm on the desk to support

if limb needs to be elevated or needs to be higher use more pillows

draped in a ‘toga’

Question 10

How to apply effleurage for lower limb?

Answer 10

start by stroking and then running hands from the feet up to the lymph nodes at the top of the leg with a V shape

apply to all areas of the leg, including underneath, always moving distal to proximal but maintaining contact with the patient at all times

Question 11

What is kneading used for?

Answer 11

to mobilise the muscles

Question 12

How to apply effleurage for upper limb?

Answer 12

hold at hand, but not tights as we don’t want sweating

start at fingers, then wrist, then arm, up the axillary node

holding hands throughout

using v shape, going round all sides of the arm

then go along the deltoid muscles and into the axillary node

Question 13

How to carry out kneading for the upper limb?

Answer 13

move proximal to distal on deltoid as it wont effect circulation

right hand in a clockwise motion and left hand anticlockwise, lifting the muscle up in the upwards motion

then go to biceps and triceps doing the same motion and moving down the arm

however, when you get to the extensor muscles, they are much smaller so use the fingers or thumb, still lifting and stretching on the upwards stroke

Question 14

How to carry out kneading for the lower limb?

Answer 14

when kneading hamstrings you can either start proximal of distal

pick up the muscle with the mid part of the hand, making sure to keep the whole hand in contact

right hand clockwise and left hand anticlockwise always

if there is a really part of muscle you can use the hell of hand to make it deeper

for a specific area you can use fingers or thumb, reinforcing with the other hand for deep massage

then move down the leg

Question 15

How to carry out picking up and ringing?

Answer 15

push down into muscle , squeeze muscle towards bone at 90 degrees with thumb towards hand, using the other hand as counterpart

move proximal to distal

don’t actually ‘pick up’ the muscle as it will pinch, make sure the muscle is in the thenar eminence

then once the muscle is relaxed you can move onto ringing

do this by pushing down into the muscle, squeezing the muscle off the bone, then take right thumb to left index finger and vice versa to carry out the ringing

if you lose the picking up of the muscle just start again, but make sure that hands stay in contact with the patient throughout

then walk slowly down the muscle

HOWEVER! -this technique should only be done when the muscle is relaxed enough

Question 15

How to prepare the client for neck and back massage?

Answer 15

fold towel in half so its equidistant around the client

hold this folded towel whilst the client lays down and roll the towels to the side

then tuck a new towel into their shorts

for the neck, wrap the towel around the patient and ask them to sit forward, with female patients remove the bra straps and tuck into the towel

if the head rest isn’t available, then keep the client upright with pillows

Question 16

What is the procedure/treatment for massaging the neck?

Answer 16

start by stroking, not crossing the spine

with effleurage, we don’t have to be too concerned with lymphatic flow because of gravity

start with SCM, coming round the middle fibres of traps into the supraclavicular node, then the paravertebrals round into axillar

then move onto kneading, starting proximal and moving distal to the upper fibres of trapezius

in between use effleurage to remove built up fluid

then go to the other side, making sure not to massage over the bone.

then do heeling

can use fingers/thumb to massage some specific tight areas when most of it is relaxed

the can do some ringing

then come down the edge of the scapula, can ask them to retract to get in the really deep spots of tightness

however, the area around the clavicle shouldn’t be pushed down and instead go 45 degrees

Question 16

What is the procedure/treatment for massage of the back (stroking part of the treatment)?

Answer 16

stroke the back avoiding crossing over spine

start on the sacrum, pushing over the top of the gluteal muscles

then up to waist and down back to nodes

then up to the bottom of ribs and down

then straight up the axillar

then paravertebral muscles, around scapula into axillar

then paravertebral muscles all the way up into supraclavicular nodes

all of the things above are stroking methods don after one another

Question 17

How to carry out kneading for the back and scapula?

Answer 17

use strokes of kneading with heel of hand on the glutei muscles, doing one side then another if you find it too hard to do both sides together

then do this on the paravertebral muscles as well and move up the muscle as you do so.

you would adjust the rate depth and rhythm to the effect that you want on the muscle

the lumbar area can have reinforced kneading

if you come across an area that’s sore you can do reinforced finger kneading

then do stroking around the scapula, flat hand kneading/effleurage, and edge of ribs into supraclavicular nodes

can then do glides of heel of hands, forming inverted V shapes, and finger kneading-as may often feel tension point here with lumps in muscles

Question 18

What should massage look like when the scapula is relaxed?

Answer 18

can get them to put arm into small of back, which lifts the scapula off

then repeat the process as you can now get at the deep muscles under the scapula

can use fingers/thumb to find the tense muscles following the scapula all the way round

Question 19

When should you use tapotement?

Answer 19

cup hands and and relax wrists, making sure air is underneath so that you don’t slap them, also stops your wrists getting tired

can use both hands at the same time, a towel is placed over the model

can vary through depth and speed depending on effect needed

if quadriceps, went don’t have to cover as we want to be stimulating, whilst stroking the quads ask the pt to tense quadriceps

Question 20

What technique to you need to make sure you know the pt for and why?

Answer 20

pinching and brushing because it’s designed to promote aggression on the skin

the pt may be a boxer so pinch over the back of clothes for stimulation

then brush hands over client, slightly pushing, note it will seem aggressive