*PTA 200- Therapeutic Massage Objectives

Question 1

Describe Therapeutic Massage

Answer 1

the 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.

Question 2

Describe Recreational Massage

Answer 2

the use of a variety of manual techniques designed to relieve stress and promote relaxation and general wellness in a person who has no definable health problem.

Question 3

What are the soft tissues of the body?

Answer 3

Skin, subcutaneous tissues, muscles, tendons, ligaments, joint capsules, nerves, blood vessels, lymph vessels, heart and lungs, abdominal organs, pelvic organs, brain, and eyes.

Question 4

What are the hard tissues of the body?

Answer 4

bones, teeth, fingers, and toenails, articular and fibrous cartilage

Question 5

Explain the purpose of soft tissue mobilization

Answer 5

a variety of manual techniques to the soft tissues of the body, designed to improve inter tissue mobility and produce pain free function.

Question 6

Describe general massage

Answer 6

a combination of different massage strokes applied to all the major regions of the body in a single treatment session in order to achieve particularly desired effects.

Question 7

Describe local massage

Answer 7

a combination of different massage strokes applied to an individual region of the body in order to achieve particularly desired effects.

Question 8

Describe focal massage

Answer 8

a combination of one or more different massage strokes applied to specific anatomical structures in order to achieve particularly desired effects.

Question 9

Describe how STM is to be used within the practice of physical therapy

Answer 9

soft tissue manipulation is used within the practice of physical therapy when it is directed at a specific patient goal. It is never applied as the only intervention. STM should be stopped once change in tissue mobility, pain, or inflammation has occurred.

Question 10

Describe the mechanical effects of massage

Answer 10

Primary mechanical effects of soft tissue manipulation;

movement of:
blood, lymph, lung secretions, chronic edema, intestinal contents.

mobilization of: muscle fibers, muscle masses, tendons, tendons in sheaths, ligaments, joint capsules, skin and subcutaneous tissue, fascia, scar tissue, adhesions, chronic hematoma.

Question 11

Describe the physiological effects of massage

Answer 11

• increased blood flow and lymph
• increased flow of nutrients
• removal of waste products and metabolites
• stimulation of the healing process
• resolution of chronic edema and hematoma
• increased extensibility of connective tissue
• pain relief
• increased joint movement
• facilitation of muscle activity
• stimulation of autonomic functions
• stimulation of visceral functions
• removal of lung secretions
• promotion of local and general relaxation

Question 12

Describe the psychological effects of massage

Answer 12

• physical relaxation
• relief of anxiety and tension
• stimulation of physical activity
• pain relief
• general feeling of well-being (wellness)
• sexual arousal
• general faith in laying on of hands

Question 13

Explain limitations of use for the application of STM

Answer 13

• cannot stand alone as the only patient intervention

- cannot replace strength training and stretching for long term changes in musculature.

Question 14

Explain how to choose the appropriate strokes as you apply STM to your patient.

Answer 14

Obviously there are many techniques available. Remember your contraindications and consider your patient’s goals. Based on how your patient presents and how they respond to the treatment gauges how you choose your technique.
Always document as “STM” or manual therapy. Avoid calling it massage. Too general and sounds like a massage parlor.
-Consider massasge sequence (general, local. and focal)
General- We do not do this.
Local- If tendon and muscle contractures are limiting joint motion, then the mobilizing effects of kneading, wringing, picking up, and deep frictions might be helpful.
Focal- When directed to treat injured skin, subcutaneous tissues, and muscle tissues.
Used for subacute or chronic edema, hematoma’s, and cutaneous scars, tendon and ligament, adhesion, contractures, colon dysfunction and muscle dysfunction.

Question 15

Describe the purpose, direction, hand placement, pressure and speed for the following massage techniques: stroking and effleurage

Answer 15

Stroking

• The entire palmar surface of the hand maintains constant contact with patient.
• To begin or finish a massage, allows patient to become accustomed to the sensation of the therapists hands.
• Can be given in any direction
• Performed at a moderate pace
• Light pressure and continuous motion

Effleurage

• Slow, stroking movement performed with increasing pressure in the direction of flow in the veins and lymph vessels. The stroke ends with a definitive pause and, whenever possible in a group of superficial lymph glands.
• Designed to move the fluid contents of the superficial veins and lymph vessels. Given in the direction of venous and lymph flow.
• Stroke should be smooth and rhythmic. Always done centripetally (toward heart).
• Performed quite slowly because the pressure exerted on the tissues is much greater than just the weight of the therapist’s hands. Pressure should increase throughout the stroke so that the venous blood and lymph are pushed through the veins and lymph channels.

Question 16

Describe the purpose, direction, hand placement, pressure and speed for the following massage techniques: petrissage (kneading, picking up, wringing and skin rolling)

Answer 16

Petrissage
-Utilized to mobilize deeper tissues.
-Firm pressure.
-Slow speed
Kneading
-Alternate compression and release of skin and underlying structures in a circular fashion. hand and skin move together. Two handed technique utilizes one hand clockwise/other hand counter clockwise movements.
-Slow speed to increase comfort. Just like kneading dough.

Picking Up

• muscle belly is grasped, slightly lifted away from the bone/fascia, squeezed and released in a circular motion.
• Slow speed to increase comfort.
• Purpose is to mobilize individual or group of muscles.

Wringing

• Two hand technique. Hands are placed next to each other along the long axis of the muscle, thumbs abducted. Squeeze the tissue and move in a circular pattern while left hand thumb and right hand 1st finger come together; repeat opposite direction.
• Purpose is to mobilize individual or group of muscles
• Demands reasonable pressure. Deep stroke designed to utilize deep muscle tissue. Do not pinch

Skin Rolling

• skin rolls over the deeper tissues. Usually two handed technique. Thumbs together, fingers together. (Make a triangle with your hands). Thumbs slightly lift and push the skin along toward the fingers, moving it overtop the underlying structures.
• Purpose is to mobilize the skin and subcutaneous structures.
• Performed quite slowly, no pinching

Question 17

Describe the purpose, direction, hand placement, pressure and speed for the following massage techniques: tapotement (clapping, beating, hacking, and pounding), vibration, shaking, deep friction (transverse and circular).

Answer 17

Tapotement
-percussion techniques. Used to clear secretions from lungs, to “tenderize” the muscles, or to stimulate muscles.
Clapping
-Used for postural drainage.
-Hands cupped with alternate quick flexion/extension of the wrists.
-One or two handed
-Performed rapidly but lightly to stimulate the tissues

Beating

• Used for postural drainage.
• Hands cupped with alternate quick flexion/extension of the wrists. Flexed fingers and palm of hand strike the part to be treated.
• Performed rapidly and more pressure than clapping

Hacking

• Hands extended, lateral aspects alternately
• Make contact with skin via wrist pronation/supination.
• Used to stimulate the skin and subcutaneous tissue and both deep and superficial muscle tissue.
• Therapist flexes the elbows and abducts the shoulders so the forearms are horizontal.
• The movement is a rapid alteration between pronation and supination of the forearms with the hands working out of phase with each other.

Pounding

• Hands in loose fist, lateral aspects make contact with skin via alternate wrist pronation/supination.
• Purpose is to stimulate deep tissue.
• Performed rapidly along the muscle to be treated.

Question 18

Describe the purpose, direction, hand placement, pressure and speed for the following massage techniques: vibration, shaking, and deep friction (transverse and circular).

Answer 18

Vibration

• As rapid as possible movements (while maintaining control), small amplitudes.
• Used for manual postural drainage techniques. Also can be used to stimulate muscles.
• Hands placed successively over each of the various lung segments

Shaking

• Slower, more purposeful movements with larger amplitudes. 3-5 shakes/second.
• Used for manual postural drainage techniques. Also can be used to stimulate muscles.
• Hands placed successively over each of the various lung segments

Deep Friction
-Specifically designed to affect the realignment of collagen in connective tissues. No lubricant in used. NOT COMFORTABLE!!!
-Very deep strokes
-Important- that the fingers do not move across the skin
Transverse friction
-Must be administered “on the spot.” Must know your anatomy and decipher appropriate direction of stroke to create friction perpendicular (right angle) to the layout of the tissue’s fibers.
-Place the tissues on a full stretch prior to administering.
-Single finger placement, unidirectional movements. -Can be used in conjunction with ice massage for improved tolerance and decreased inflammation.
-Slow steady rhythm
Circular friction
-Stationary circles that gradually progress in depth. “Hurts so good…”
-Use tripod fingers
-Performed along the long axis of the muscle
-Slow steady rhythm

Question 19

Recognize contraindications for use of STM as a physical therapy intervention.

Answer 19

Acute infection
Open wounds
Over frail skin with edema
3-6 months after radiation treatment
Hyperesthesia
Cancer
Large varicose veins, thrombophlebitis, DVT
Psoriasis, eczema, dermatitis

Question 20

Recognize potential indications for use of STM as a physical therapy intervention.

Answer 20

Pain
Muscle spasm
Superficial scar
Edema
Muscle contractures
Muscle stimulation
Respiratory disorders
Collagen re-alignment