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Contraindications

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A sign, symptom, evaluation or diagnosis that directs the therapist to avoid a certain procedure

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Indications

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A sign, symptom, evaluation or diagnosis that directs the therapist to apply a certain procedure

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Cautions

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A sign, symptom, evaluation or diagnosis that directs the therapist to be prepared to modify a given procedure in order to reduce the risks associated with its application

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Sequencing Massage Techniques- 3 steps

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Summarize clinical findings and outcomes Select treatment techniques Specify scope and duration of sequence of techniques

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Wellnes

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encompassing both a balance of "mind, body, and spirit" and an individuals' self-perception of their well-being, which is distinct from their state of "health."

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Parts of Intelligent Touch

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Attention and Concentration Discrimination Identification Inquiry Intention

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Attention and Concentration

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Therapists' capacity to focus on the sensory information that they receive primarily, but not exclusively, through their hands

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Discrimination

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Therapists' ability to distinguish fine gradations of sensory information

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Identification

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Therapists must be able to distinguish between healthy and dysfunctional tissue states. In addition, they must be able to identify structures and their response to applied forces.

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Inquiry

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Intelligent Touch is inquiring touch. Good therapists are constantly asking questions.

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Intention

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Therapist's aim of using massage techniques to produce a more normalized response of the client's tissues or other structures

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Four Principles of Massage

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General-Specific-General Superficial-Deep-Superficial Proximal-Distal-Proximal Peripheral-Central-Peripheral

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Superficial Reflex Technique

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Engage only the skin and may produce reflex effects but no mechanical effects

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Superficial Fluid Technique

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Engage the skin, superficial fascia, and subcutaneous fat down to the investing layer of the deep fascia Produce mechanical effects on superficial lymphatics and possibly the venous circulation

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Neuromuscular Techniques

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Engage muscle and the tissues it contains Affect the function of the contractile element, connective tissue hydration, and lymphatic return May also produce complex reflex effects

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Percussive Techniques

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Deform and release tissues quickly Engage different tissues depending on the force with which therapists apply them May also produce useful reflex neuromuscular effects

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Connective Tissue Techniques

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Engage superficial and deep layers of connective tissue Mechanically affect the hydration, extensibility, and modeling of connective tissue; may also produce complex reflex effects

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Passive Movement Techniques

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Produce substantial tissue or joint motion without effort on the part of the client Engage multiple tissues and structures and have wide-ranging effects on fluid flow, connective tissue, and the neural control of muscle tone

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Superficial

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Pertaining to or close to the surface

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Reflex

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an involuntary reaction in response to a stimulus applied to the periphery and transmitted to the nervous centers in the brain or spinal cord

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Mechanical Effects of Massage

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Are caused by physically moving tissues, by: Compressing Stretching Shearing Bending Twisting

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Static Contact

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Motionless contact of the therapist's hands with the client's body, performed with minimal force The least mechanically forceful of the massage techniques An important part of systems such as Therapeutic Touch, Reiki, and Polarity Therapy

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Fine Vibration

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Fast oscillating or trembling movement produced on the client's skin with minimal deformation of subcutaneous tissues Manual technique is hard to perform long enough to be effective. Perform using a machine that vibrates at 100 Hz

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Superficial Stroking

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Gliding over the client's skin with minimal deformation of subcutaneous tissues Usually applied unidirectionally over large areas of the client's body Often used at the beginning or end of a region or intervention

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Static Contact Contraindications and Cautions

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Contraindicated in areas of acute inflammation because of pain Clients who have much pain or distress may not tolerate touch at all. Be sensitive to the needs of frail, high-risk, or terminally ill clients. Even though static contact causes minimal mechanical effects, it can give rise to complex physical and emotional responses, including touch-triggered memory.

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Superficial Stroking Contraindications and Cautions

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Contraindicated in areas of acute inflammation because of pain Clients who have much pain or distress may not tolerate touch at all. Be sensitive to the needs of frail, high-risk, or terminally ill clients. Recent myocardial infarction With bypass surgery, wait 48 hours. Ticklishness: use a broader contact, more lubricant, or more pressure

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Fine Vibration Contraindications and Cautions

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When pain is due to acute inflammation, the weight of a hand or of a machine may not be tolerated locally

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Fluid

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in this context, fluid refers to lymph and venous blood

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Superficial Fluid Techniques Have:

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Mechanical effects caused by the compression and stretching of vessels Reflex effects caused by: The stimulation of cutaneous afferents The rhythm and tempo of their application

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Superficial Effleurage

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A gliding technique performed with light pressure in the direction of venous and lymphatic flow that deforms tissue down to the investing layer of the deep fascia Affects the layer of superficial fat and fascia, which contains many veins and lymphatics is one of the 5 techniques of Swedish massage.

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Effleurage

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A gliding technique performed with light pressure in the direction of venous and lymphatic flow that deforms tissue down to the investing layer of the deep fascia Affects the layer of superficial fat and fascia, which contains many veins and lymphatics one of the 5 techniques of Swedish massage.

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Superficial Lymph Drainage technique

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A nongliding technique performed in the direction of lymphatic flow, using short, rhythmic strokes with minimal to light pressure, which deforms subcutaneous tissue without engaging muscle Affects the layer of superficial fat and fascia, which contains terminal lymphatics Developed in 20th century by Emil Vodder into "Manual Lymph Drainage"; MLD now has several schools Increases return flow of lymph Reduces edema Stimulates formation of new lymphatic pathways after damage to lymphatics Used to treat lymphedema in context of Complete Decongestive Therapy Can be used to relax or sedate

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Cautions and Contraindications of Superficial Lymph Drainage

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Acute systemic or local inflammation Untreated metastatic cancer Allergic reactions Thrombosis Congestive heart failure Cautions: asthma, low blood pressure, during menstruation

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Neuro

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in this context, the prefix "neuro" refers to the neurologic control of muscle length and the associated level of resting tension.

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Muscular

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in this context, "muscular" means that, while applying the technique, the therapist palpates and directs force towards muscle tissue.

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Mechanical Effects of Neuromuscular Massage

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Mechanical effects may be caused by: Compression and stretching of muscle fibers Tension applied to connective tissue wrappings associated with muscle Pushing of fluid in vessels that pass through muscle

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Reflex Effects of Neuromuscular Massage

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Reflex effects may be caused by: Stimulation of proprioceptors (muscle spindles and Golgi tendon organs) Entrainment to the rhythm and tempo of application Stimulation of the reflex areas of the feet, or of meridians

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Neuromuscular Techniques

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Broad Contact Compression Forms of Petrissage Specific Compression Muscle Stripping

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Broad Contact Massage

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A non-gliding technique that engages the client's muscle; the pressure and release of the stroke are perpendicular to the surface of the client's body Is delivered with a broad-contact surface such as the palm Is commonly used in sports massageMay increase venous and lymphatic return Can assist expiration when applied to rib cage Can be sedative or stimulating Used to assess the level of muscle resting tension

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Petrissage

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A group of related techniques that repetitively compress, shear, and release soft tissue—primarily muscle—with varying amounts of drag, lift, and glide One of the 5 techniques of Swedish (classical) massage Five main varieties are: muscle squeezing, wringing, picking-up, broad-contact kneading, specific kneading Reduces anxiety Improves immune function Reduces pain Possibly reduces level of muscle resting tension Possibly improves fluid return Has positive effects on conditions such as as headaches, trigger point syndromes, low back pain, and fibromyalgia

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Muscle Squeezing

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Form of Petrissage,Is effective through clothing Grasp, squeeze, and hold muscle belly with whole hand. On small muscles, squeezing can be done between the thumb and index finger.

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Contraindications and Cautions of Broad Contact and specific Compression

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All general and local contraindications for mechanical techniques apply (see Chapter 3) Some common considerations: Osteoporosis Anticoagulant drugs Spasm Active trigger points

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Contraindications and Cautions of Petrissage

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All general and local contraindications for mechanical techniques apply (see Chapter 3) Some common considerations: Osteoporosis Anticoagulant drugs Spasm Active trigger points

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Wringing

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Form of Petrissage, Start with hands on opposite sides of the circumference of a body segment like the thigh or the back. Slide your hands toward each other, compressing, lifting, and shearing the muscle between them as they pass. Repeat with your hands going in opposite directions. Use enough force to shear the muscle, not just the skin and fat.

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Picking Up or C cupping

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Abduct your thumb so your hand forms a C-shape, with the four fingers grouped together in adduction. Grasp and squeeze muscle, while gliding your hand in a centripetal direction. Lift the tissues off the underlying bone. Glide back to starting position with minimal pressure, and then repeat.

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Broad Contact Kneading

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Form of Petrissage, Use a broad contact such as the palm. Compress into muscle and then glide centripetally. Lighten pressure and return. Pressure strokes and return strokes form circles or ellipses that are oriented along or across the fibers in the different muscle layers. Access deeper muscles by using body weight through controlled leaning.

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Specific Kneading

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Move fingers or thumbs (the hand remains largely stationary). Compress into muscle and then glide centripetally. Lighten pressure and return. Pressure strokes and return strokes form small circles or ellipses. Stabilize by having the heel of the hand in contact, and/or reinforce to support the small contact surface.

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Percussion

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Repeated rhythmic light striking Controlled striking of the body quickly deforms and releases tissues Also known as "tapotement"

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Mechanical Effects of Percussive

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When applied over rib cage, rapid compression and release of rib cage sets up a vibration that travels through the chest wall and lung tissue, dislodging stuck mucus. This mechanical effect is usually augmented with postural drainage (positioning for drainage).

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Reflex effects or percussive

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Intense sensory stimulation may cause increased alertness. Spinal gating may cause analgesia. Repeatedly stimulating stretch receptors (spindles) within the muscle may temporarily and marginally increase neuromuscular tone in abnormally innervated muscles.

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Percussive Techniques

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Pincement, Tapping, Hacking, Slapping, Cupping, Beating, Pounding

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Percussive Uses and outcomes

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Improves airway clearance (clapping) Increases arousal (alertness) Reduces pain Used for proprioceptive stimulation (tapping)

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Percussive Contraindications and Cautions

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All general and local contraindications for mechanical techniques apply (see Chapter 3). Rib fracture Coronary thrombosis, unstable cardiac condition, pulmonary embolism After chest or spinal surgery During an acute episode of asthma Postural drainage has additional contraindications and cautions. Acute and subacute injuries Spasm, cramping, trigger points Where muscle tone or bulk are less than normal Over bony prominences (clavicles, spinous processes) and lower ribs Over the kidneys Around the face

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Mechanical effects of Passive Movement

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Compression and release of soft tissue may produce modest increases in lymphatic and venous return. Deformation of joint capsules moves synovial fluid through the capsule. Shaking applied to the rib cage moves mucus in bronchial tree.

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Reflex effects of Passive Movement

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Rate and rhythm can sedate or awaken. Stimulation of joint afferents enhances joint awareness. Movement helps clients to become aware of unnecessary muscle tension. Proprioceptive input may reduce resting tension of muscle. Vestibular reflexes may cause a generalized decrease in postural tone.

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Passive Movement Techniques

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Shaking, Rocking, Rythmi mobilization

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Shaking

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Repetitively moves soft tissue—primarily muscle—back and forth over the underlying bone, with minimal joint movement Used in pre-event and inter-event sports massage Sometimes classified as a form of petrissage Used to reduce "holding" or unnecessary muscle tension Used to prepare for procedures such as joint play May marginally reduce the resting muscle tension of skeletal muscles Enhances arousal if done briskly Pleasant

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Shaking contraindications and cautions

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all general and local contraindications for mechanical techniques apply Acute injuries, even distant from area of application, because of the movement Spasm Hyper-reflexia or spasticity

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Rhythmic Mobilization

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Repetitively moves entire structures, resulting in the movement of soft tissue over bone and the movement of the related joints and internal organs May result in simultaneous movements in several related joints Prominent in the work of: American physician Milton Trager (Trager Psychophysical Integration) British osteopath Eyal Lederman (Harmonic Technique) Used to reduce "holding" or unnecessary muscle tension Used to prepare for procedures such as joint play Reduces muscle resting tension Mobilizes stiff joints, enhances joint awareness, and stimulates joint healing Mobilizes bronchial secretions Can have a calming, soothing effect

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Rhythmic Mobilization cautions and contraindications

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All general and local contraindications for mechanical techniques apply (see Chapter 3) Acute injuries, even distant from area of application, because of the movement Spasm Hyperreflexia or spasticity Vertigo, motion sickness Do not perform too quickly, or it becomes unpleasant.

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Rocking

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Gentle, repetitive oscillation of the pelvis and torso that results in waves of motion that travel along the body A 20th century innovation Prominent in the work of: American physician Milton Trager (Trager Psychophysical Integration) British osteopath Eyal Lederman (Harmonic Technique) Profoundly sedative if done well Useful for stress, anxiety, and insomnia May reduce unnecessary muscle tension and muscle resting tension May reduce perception of pain

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Rocking Contraindications and cautions

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All general and local contraindications for mechanical techniques apply (see Chapter 3) Acute injuries, even distant from area of application, because of the movement Vertigo, motion sickness Do not perform too quickly or abruptly or it becomes unpleasant! May cause mild disorientation

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What does health history provide?

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Provides: Basic information about client Age, name, occupation, gender, address etc. Current or previous disorders/diseases Eg. Diabetes, High BP, Cancer, Skin disorders, Soft tissue disorders etc. Current Medications Important for CIs & Cautions Current or previous Injuries & Surgeries May involve current symptoms, CIs or Cautions Seeking Other Health Care Dr. name & Address, Chiro, Physio, Psych etc.

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