Treatments - Massage

Question 1

What is therapeutic massage

Answer 1

> Manipulation of soft tissue by therapist
(component of holistic therapeutic intervention)

*mainly used as an adjunct to allow better exercise and facilitate neuroplasticity

Question 2

When do we use it?

Answer 2

> Reduce pain
Reduce anxiety/stress
insufficient evidence to show it reduces spasticity in stroke or MS populations

Question 3

Effects of massage

Answer 3

> Mechanical

• mobilisation of tissue (skin/contractile/non-contractile/scar tissue)
• movement of fluid (oedema/lymph/blood/mucus)

> Physiological 
- Circulatory : Venous + lymphatic flow 
                     : Skin reddening 
- MSK: muscle tissue 
          : connective tissue 
- Nervous: pain relief (pain gate)
                 : autonomic response (fluid balance + receptor sensitivity)
- Hormonal system 
- Immunological system 
*Increased lymphocyte markers whilst decreasing cytokine 

> Psychological effects 
- reduced anxiety 
- reduced muscle tension
- reduced perceived pain 
- better mood/relaxation 
PLACEBO?

Question 4

Therapeutic relationship

Answer 4

> Based on:

• respect
• trust (+confidentiality)
• communication
• client-centred care
• understanding of power relationships (think about vulnerability + emotional responses)

Question 5

Ethical considerations

Answer 5

> Informed consent
> inappropriate behaviours
> maintain clear communication
> maintain boundaries (confidentiality)
> privacy + dignity

Question 6

Indications

Answer 6

> Soft tissue damage 
> oedema
> adverse neural dynamics
> pain 
> venous ulcers (less so in modern day)

Question 7

Contraindications

Answer 7

> Open wound 
> Circulation problems 
- DVT (embolus risk)
- haemophilia 
> haemorrhage 
> early stages of healing (disrupt collagen formation)
- fracture 
- soft tissue 
> Infection
> Inflammation
> active bone growth - kids growth plates
> skin conditions
> cancer
> foreign body

Question 8

Precautions

Answer 8

> malignant disease
> fragile skin
> collagenous weakening (steroids/diabetes/RA)
> heart problems (extra stress on heart)
> dermatomyositis (muscle infection)
> over endocrine glands

Question 9

Procedure

Answer 9

> Consent
appropriate exposure - can massage but also dignity
patient = warm + comfortable
area = well supported
*medium to reduce friction? (allergy check)

Aims:
> aid venous/lymphatic return ie boost waste removal 
> light - decrease tone
> deep - increase tone
> passively stretch fibres
> increase tissue mobility + length 
\+ petrissage can increase extensibility + strength of Connective tissue 
\+ promote somatovisceral reflex effects

Question 10

Techniques

Answer 10

> Effleurage
- smooth stroking towards proximal lymph glands

> Petrissage

• kneading
• avoid if painful or on sensitised tissue
• Combine petrissage with stretching (can ask for help to stop patient rolling off bed)
• *Don’t reduce useful tone e.g tenodesis grip