Therapeutic Massage
Chapter 16
Historical Perspective
Dating back to the ancient Olympians
 Late 1980’s

– American Massage Therapy

1992
– National Certification Examination for
Therapeutic Massage and Bodywork
Purpose

Manipulates the the body’s tissues to:
– Reduce muscle spasm
– Promote relaxation
– Improve blood flow
– Increase venous drainage

Broad range of massage theories,
techniques, and effects
Types of Massage
Basic Massage Strokes
 Effleurage
 Pétrissage
 Friction
 Tapotement
 Vibration
Myofascial Release
 J-Strokes
 Focused Stretching
 Skin Rolling
 Arm Pull / Leg Pull
 Diagonal Release
Effleurage
“Stroking of the skin”
 Spread massage lubricant
 Use at the beginning and end
of the massage
 Superficial:

– slow strokes for relaxation

Deep:
– Elongates muscle fibers
– Stretches fascia
– Forces fluids in the direction of
the stroke
 towards the heart
Pétrissage
“Lifting and kneading”
 Frees adhesions:

– Stretches and separates
muscle fiber, fascia, and
scar tissue

If only technique used,
it may be performed
without the use of
lubricant
Friction
“Deep pressure”
 Effects muscle mobilization, tissue
separation, and trigger points
 Two types:

– Circular
– Transverse
Circular Friction Massage

Use a circular motion
– Thumbs
– Elbow
– Commercial device
Transverse Friction Massage
Strokes perpendicular to
tissue fibers
 The thumbs or fingertips
stroke in opposite
directions

Tapotement
“Tapping or pounding” of the skin
 Variations:

– Hacking
– Cupping
– Pincement (pinching)
– Rapping
– Tapping
Tapotement Technique
Performed with a light,
fast tempo
 Promotes muscular and
systemic relaxation and
desensitization of
irritated nerve endings

Vibration
“Rapid Shaking”
 Increases blood flow and provides
systemic invigoration of tissues
 Mechanical devices available

Myofascial Release

Stroking and stretching of tissues:
– Relax tense tissues
– Release adhered tissues
– Restore tissue mobility

Clinician receives cues and feedback from the
patient’s tissue
– This indicates the appropriate strokes and stretches

Specialized training in myofascial release
techniques is needed to become proficient in
these skills
J-Strokes
One hand places the
adhesion on stretch
 Other hand’s 2nd and 3rd
fingers stroke in the
opposite direction forming
a ‘J’
 Mobilize scar tissue

Focused Stretching
Heel of one hand in the area of restriction
 Heel of other hand crossed in front
 Stretch the tissue using slow, deep pressure
 Reduces superficial or
deep adhesions

Skin Rolling

Use fingers and thumb to
lift and separate the skin
from the underlying tissue
– Similar to Pétrissage
Roll skin between fingers
noting restriction
 Lift skin and move it in the
direction of the restriction
 Reduces superficial
myofascial adhesions

Arm Pull/Leg Pull





Arm pull (example):
Grasp extremity proximal to
wrist
Apply gentle traction that is in
line with anterior deltoid
Continue to abduct 10-15
degrees until full abduction is
reached
Stretches large areas of fascia
Diagonal Release
One clinician grasps the leg proximal to
talocrural joint
 Other grasps the opposite arm proximal to
wrist
 Keep extremities horizontal to each other
 One moves the limb until adhesions are
felt while the other stabilizes the extremity
 Stretch large area of fascia

Physiological Effects

Cardiovascular
– Increase blood flow, histamine release, and temperature
– Decreased heart rate, respiratory rate, and blood pressure

Neuromuscular
– Increase flexibility, decrease neuromuscular excitability
(relaxation), edema reduction, and stretch muscle and
scar tissue

Pain
– Activate spinal gate and the release of endogenous
opiates

Psychological
– Reduces patient anxiety, depression, and mental stress
Indications







Increase blood flow
Facilitate healing
Increase range of motion
Remove edema
Alleviate muscle cramps
Stretch scar tissue/adhesions
Decrease pain
Contraindications
Acute inflammatory conditions
 Severe varicose veins
 Open wounds
 Skin infections
 Failed or incomplete fracture healing
 Thrombophlebitis

Preparation
Table
 Linens and pillows
 Massage lubricant
 Patient position
 Masseuse position

Traditional Massage






Apply massage medium
with light, slow
Build to deeper effleurage
Pétrissage
Wipe medium before
applying deep friction (if
applicable)
Reapply pétrissage and
deep effleurage
End with light effleurage
Edema Reduction
Massage
Preparation
Elevate the body area
 Apply massage lubricant to the skin
 Clinician is positioned distal to the
extremity

Stroke Sequence




Begin proximal to the
edematous area
Long, slow, deep strokes
towards the torso
Move starting point
slightly distal every fourth
or fifth stroke
When the starting point
moves distal to the
edema, begin working
back towards the starting
point
Termination
Remove medium
 If appropriate:

– Active range of motion exercises
– Compression wrap

Encourage patient to drink water to assist
in flushing metabolic waste