technique review

8/13/2019 Technique Review

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Techniques & Conditions Review

TECHNIQUES

1. Effleurage: Used to address and effect circulation. Moves blood and lymph on a superficial

level and warms the tissue in two ways

(1) Skin on skin contact increases heat(2) Increased circulation makes the tissue more supple and therefore prepares it

for deeper work

Considered the technique used to ease or lengthen a spasm because it isthe least invasive or jarring.

Considered a technique that glides – pressure is applied evenly throughentire stroke. Pressure can deepen with each successive stroke.

Considered a diagnostic stroke. Effleurage may be referred to on exam as: Gliding, Stroking, Bi-lateral Tree, Shingles

2. Petrissage:Also designed to address and effect circulation. It does everything Effleurage does

but does it at a deeper level. Designed to effect muscle bellies. Mimics the action

of skeletal muscle contraction.

Petrissage is like putting water on a dry sponge. By filling the musclewith fluid (blood) it becomes soft and pliable (like the sponge). The

warmth of the blood also adds to pliability.

Bringing warm fluid to area makes it ready for deeper work. Then youare able to either work through the tissue itself, or pick it up and move it

out of the way to work underneath the tissue.

Increased circulation to the area clears waste product from tissue – thefocus is on the muscle belly

Petrissage may be referred to on exam as: Chucking, Milking, Rolling, Wringing,

Kneading


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3. Friction:Mechanical technique utilizing, finger, thumb, knuckle, tool etc. to destroy

adhesions by locating stuck tissue of any combination of muscle, bone, fascia etc.

and breaking it down.

GIVES TISSUE THE POTENTIAL FOR MOVEMENTUsed around joints and along bony surfaces it is considered a technique to regain

mobility.

Produces local hyperemia.Increase in circulation is warm fluid and increases the mobility potential. Increased

circulation is a by-product of the technique but not the primary motive.

Friction may be referred to on exam as: Parallel Friction, Circular Friction, and

Longitudinal Friction etc.

4. Vibration & Tapotement:Considered the least used Swedish massage

Vibration addresses and affects the nervous system

Tapotement addresses and affects the skeletal muscle.

Length of time the technique is applied determines the physiological effect

In a local fixed area, vibration and/or tapotement effects:

0 – 10 seconds Stimulates the tissue

10-60 seconds Calms , relaxes, sedates, soothes, eases etc.

60 seconds or more Exhausts the tissue

(good for hypertonic muscles i.e. lower back muscles – lordosis)

5.

Heat & ColdHot Pack – Dilates blood vessels

Max Temp 110°

Cold Pack – Constricting to blood vessels

32° - 55° considered a cold pack


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6. Exercise:Passive: Therapist moves the client, client does nothing

Passively stretches the tissues Breaks down adhesions deep in the joint that the massage therapist

cannot reach

There is more ROM with PROM than AROM

Active: Massage Therapist tells client, what to do and the client does it.

Builds Muscle strength Moves circulation

Resisted: Active movement with resisted action

Builds Muscle strength

7. Contraindications/Precautions/Cautions1

st step is to determine if contraindications are present by asking the client questions

about current state and medical conditions.

General Contraindications:

Fever Systemic or Infective– puss, acute rheumatoid arthritis, cancerous tumors

Abdominal Massage Contraindications:

Women having their period

Bleeding Ulcer High Blood Pressure

Local Contraindications

Varicose Veins (can work around them to increase collateral circulation) Broken Skin


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Bedsores – caused by lack of circulation – move gentle circulationtowards the wound area without disturbing (do NOT shift the skin of the

wound) the center of the wound – produce local hyperemia – vibrate

around are while gauze is domed over the bedsore – the vibration flutters

through the wound and stimulates the fibroblasts – a.k.a. also called

decubitous ulcers

8. Other Names to KnowQuestion contains Answer Other Info

Bindegeswebbmassage Elizabeth Dickie applied to connective tissue between the

skin & the muscle (fascia) – dermatomes

Trigger Point Therapy Janet Travel TP’s are areas of hyperirritability can be

in bone, muscle, fascia etc. Satellite TP’s

& referred pain – twitch/jump response

James Cyriax Transverse Friction

CONDITIONS

1. Acute v. Chronic Acute Phase – goal: decrease swelling

The longer swelling is present the more adhesions develop. Toxins in

immobilized area settle. The less the solutions hovers, the less adhesions.

Elevate Circulation strokes proximal to distal (effleurage & petrissage) Ice

Chronic Phase – goal: increase mobility

Friction & PROM


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2. Tendonitis Irritant is triggering tendon, repetetive use. It is an ongoing low-level irritant so

there is no real acute phase.

Chronic Tx

Friction – realigns fibers and reduces adhesion Address misrecruitment of Muscles – Massage Therapist needs to aid in

breaking of substitution habits due to muscle disuse

Ice – to counter irritation of tendon because of friction tx CAUTION during PROM is overstretching Rehab Exercises: Eccentric contraction is easier and the best way to start

point for rehab

3. Traumatic InjuriesExample: Ankle Sprain - Inversion sprain is the most common

First question to ask is “Have you had an x-ray?” must confirm no fractures

before treatment

Acute Tx (lots of swelling)

Elevate Ice Proximal/distal circulation massage Chronic Tx (adhesions & lack of mobility)

Friction - creates potential for movement PROM – increases mobility Exercises

PROM1. Dorsi & Plantarflexion2. Eversion3. Inversion (last because peroneals compromised)

RIT – increases mobility Eversion last because peroneals compromised


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4. Fractures Example: Colles Fracture

Tx

Immobilize Wrist (cast) Elevate Proximal & some distal circulation massage (work areas exposed on both

ends of cast)

Maintain muscle tone while in cast (i.e squeeze ball for flexors, extendfingers against rubberband for extensors) – this is a pumping action which

will lessen atrophy and adhesions – pumps circulation which is good for

all healing

After cast is removed

Initially – circulation strokes and PROM with exercises increase atrophiedmuscle tone

Exercises 1. Easiest movements first - Flexion & Extension of the wrist (w/soup

can eccentric contraction)

2. Radial & Ulnar deviation (PROM & RIT) 3. Pronation (PROM & RIT)

When muscle tone returns, start friction to adhesions

5. Deformities of the spine Example: Kyphosis, Lordosis, Scoliosis

Treat shortened muscles first

6.

Neuralgias/Neuritis a. Example: Bell’s Palsy – impacts CN VII - commonly sat under a draft and the

nerve is irritated, ½ of the face becomes flaccid

Note: Be careful with flaccid tissue, as tissue is non-responsive. A

minimal amount of work can exhaust the tissue.


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Treatment:

Short bursts of work (30 seconds) in an upward direction. i.e. lightfingertip tapotement, short effective petrissage in upward direction

Work elsewhere for 3 minutes or more Short bursts of work (30 seconds) in an upward direction – move on,

repeat etc.

Rehabilitation

Have client cover unaffected side of face w/a piece of paper and look inthe mirror. Have client work affected side by trying to smile, speak, make

vowels & facial expressions. The covering of the unaffected side enables

the client to notice any small changes on the affected side. This

acknowledgement works as positive reinforcement.

b. Impingement/Entrapment on nerve plexusExample: Brachial Neuralgia - Nerve pain response is to contract in splint/spasm

– this increases compression creating pain/spasm/pain cycle - if at all possible go

to the original site of problem i.e. if it is a contracted muscle…Tx

Slacken the contracting muscle Work in slackened position to alleviate pressure on plexus Soften splinting muscle

Sciatica – if cause is a herniated disc, you can not treat this but can work

reponding muscle

Pregnancy – if nerve entrapment is baby pressing on nerve, have woman go on

all fours so the baby will float and alleviate pressure

Other Tx –

Confuse the muscle with jostling at random arbitrary movement patterns –

i.e ruddering of femur by flexing knee, holding ankle, occasionally sneak

in a stretch

7. Flaccid/Spastic Paralysis –note tissue is not normal tissue (1) Flaccid

Immediately start PROM, effleurage and petrissage


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Say it, show it, imagine it – client should receive multisensory inputduring rehabilitation – as many ways as possible to keep the

neuromuscular connection

Gentle movement Short bursts – the muscle is easily exhausted – minimize ° PROM

(2) Spastic Random movments to confuse/shift neuromuscular pattern When the muscle “quiets” gentle PROM Then soften spastic muscles

(3) Amputee Sever the neuromuscular pathway Get patient to look at the stump & handle it Lots of tapotement at stump – short bursts NOT to the point of exhausting

the muscle

8. Respiratory DrainageExample: Cystic Fibrosis

Prone: Head of table lower than feet Sputum cup, bucket w/disinfectant, tissues & garbage pail Tapotement over lungs – spit – tapote – spit etc.

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