MEDICAL MASSAGE (RHPT 363)
DEFINITION
Massage is the systematic and
manipulation of the soft tissues of the body.
scientific
Types of massage
1. Manual massage
2. Mechanical massage
Massage can also be applied by
electrical equipment such as vibrators, rollers and etc.,
Purpose of Massage
The purpose of massage is to bring about any of the physiological,
mechanical, or psychological effects.
Relaxation, relief pain, reduction of certain types of edema, and
increased range of motion can be accomplished through the use of
massage.
Massage metabolically prepare the injured or involved muscles for
exercise to their fullest capacity, but it will also encourage the confidence
In addition to the treatment of injured or ill people, massage can be
used to prepare healthy muscles for strenuous sports activity, or to assist
the body in recovering from the aftereffects of such activity.
Massage is a useful and integral part of the healing process.

Two basic principles should be kept in mind at
all times
1.The therapist should have knowledge of the
patient’s complete diagnosis , so that massage
can be done as part of the patient’s total
treatment plan.
2. Physical contact establishes a close
relationship between operator and patient. This
contact should be understanding and
sympathetic, but never personal.
1. Personal appearance
The personal appearance of the operator should be above scolding.
Clothing should be neat, clean, and comfortable, allowing freedom of
motion.
2. Surroundings
Massage can be given at almost anytime or place. It is important that
room temperature should be warm enough so that the patient is
comfortable.
A calm, peaceful, and cheerful atmosphere should be maintained.
Neatness and cleanliness should be most evident ; clean towels and
sheets as well as other well- maintained equipment should be neatly
arranged.
3.Care of the hands, wrists and fingers
The hands are all important in giving massage
- hands should be washed before every treatment,
and rings should not be worn because they might
scratch the patients.
- the fingernails should be cut short.
- the hands should always be warm and dry.
- the therapist should do exercise to keep the fingers
strong and to avoid pain.
4. Posture
Attention to good posture is essential to avoid
fatigue and backache.
The weight should rest evenly on both feet with
the body in good postural alignment.
When massaging larger area, the weight should
shift from one foot to the other.
A good operator can apply pressure by a shift of
body weight instead of using muscle strength.
5.Treatment table
The treatment table should be of wood or metal with a firm pad or a
mattress without springs.
The treatment table should be the right height to allow for correct postural
balance of weight.
6. Plinth height
stand side-on to the couch, resting your hand on it with the fingers loosely flexed
at the metacarpophalangeal joints and elbow not quite fully extended.
Adjust the height of the couch until you can comfortably rest your hand as
above.
7. Positioning of the patient
Specific positioning depends upon the areas of the massage.
In general, the part to be massaged should be elevated in order to allow
gravity to assist the venous return.
8. Draping
Tight clothing should be removed and a sheet or towel used to cover the parts of
the body not being treated.
The patient should not be unnecessarily exposed.
9. Contact medium
The purpose of a lubricant is to avoid uncomfortable friction between the hand
of the operator and skin of the patient.
There are many types of lubricants.
- lanolin oil
- mineral oil or baby oil
- olive oil
- powder (odorless)
Care should be taken to avoid application of too much of lubricants since it
prevents firm contact and the hands can slip over the surface of the skin.
10. Feedback
The therapist can improve his techniques if he gets feedback
from the patients about the pressure and comfortability.
11. Pressure and Rhythm
Pressure should be adjusted to the contours of the body and
care should be taken over bony areas.
All massage should begin lightly, as depth of the stroke
increases, the operator increases the pressure but it should not be
greater than tolerability of the patient.
It is important to maintain physical contact with the patient
once the treatment begins.
12. Rest
Rest for the patient following treatment is always
advised, especially in cases where the involved part is a
weight bearing limb.
Length of time for this rest must be judged by the
operator.
13 .Duration
Depends upon the part of the body treated.
The Origin of Lymph

Lymph originates as plasma, which is the fluid portion of blood. The arterial
blood that flows out of the heart slows as it moves through a capillary bed.
This slowing allows some plasma to leave the arterioles and flow into the
tissues where it becomes tissue fluid.

Also known as intercellular fluid, or interstitial fluid, this tissue fluid delivers
nutrients, oxygen, and hormones to the cells.

As this fluid leaves the cells, it takes with it cellular waste products and
protein cells.

Approximately 90 % of this tissue fluid flows into the venules. Here it enters
the venous circulation as plasma and continues in the circulatory system.

The remaining 10 % of the fluid that is left behind is now known as lymph.
Lymphoid tissue

Lymphoid tissue associated with the lymphatic system is
concerned with immune functions in defending the body
against the infections and spread of tumors. It consists
of connective tissue with various types of white blood cells
enmeshed in it, most numerous being the lymphocytes.
A lymph node

There are between 600-700 lymph nodes present in the
average human body. It is the role of these nodes to filter the
lymph before it can be returned to the circulatory system.
CARDIOVASCULAR SYSTEM
(BLOOD)
LYMPHATIC SYSTEM
(LYMPH)

Blood is responsible for collecting and
distributing
oxygen,
nutrients
and
hormones to the tissues of entire body.

Lymph is responsible for collecting and
removing waste products left behind in the
tissues.

Blood flows in a closed continuous loop
throughout the body via the arteries,
capillaries, and veins.

Lymph flows in an open circuit from the
tissues into lymphatic vessels. Once within
these vessels, lymph flows in only one
direction.

Blood is pumped. The heart pumps blood
into the arteries that carry it to all of the
body. Veins return blood from all parts of
the body to the heart.

Lymph is not pumped. It passively flows
from the tissues into the lymph capillaries.
Flow within the lymphatic vessels is aided
by other body movements.

Blood consists of the liquid plasma that
transports the red and white blood cells and
platelets.

Lymph that has been filtered and is ready
to return to the cardiovascular system is a
clear or milky white fluid.

Blood is filtered by the kidneys. All blood
flows through the kidneys where waste
products and excess fluids are removed.
Necessary fluids are returned to the
cardiovascular circulation.

Lymph is filtered by lymph nodes located
throughout the body. These nodes remove
some fluid and debris. They also kill
pathogens and some cancer cells.
Functions
The lymphatic system works in close cooperation with other body
systems to perform these important functions:

The lymphatic system aids the immune system in destroying pathogens
and filtering waste so that the lymph can be safely returned to the
circulatory system.

To remove excess fluid, waste, debris, dead blood cells, pathogens, cancer
cells, and toxins from these cells and the tissue spaces between them.

The lymphatic system also works with the circulatory system to deliver
nutrients, oxygen, and hormones from the blood to the cells that make up
the tissues of the body.

It absorbs and transports fatty acids and fats to the circulatory system

Lymphedema is the swelling caused by the accumulation of
lymph fluid,[6] which may occur if the lymphatic system is
damaged or has malformations. It usually affects the limbs,
though face, neck and abdomen may also be affected.

Some common causes of swollen lymph nodes
include infections, infectious mononucleosis, and cancer.

Parasitic infection (Filariasis)
1. Effects on circulatory system
2. Effects on mobility of soft tissue
3. Effects on metabolism
4. Effects on respiratory system
5. Effects on excretory system
6. Effects on nervous system
7. Psychological effects.
1.Effects on circulatory system
Assists in venous Flow
When normal activity is inhibited by injury or illness, this will result in
decreased circulation.
The mechanical effect of deep stroking on the superficial veins in the direction
of venous flow will increase arterial circulation. when possible, gravity should be
considered to assist.
Assists Lymphatic Flow
Lymph is a viscid fluid that moves slowly through the lymphatic system.
Movement of lymph depends upon outside forces such as contraction of muscles
and pressure generated by filtration of fluid from the capillaries. Immobility due
to pain or paralysis seriously interferes with lymph drainage.
Massage strokes can encourage lymphatic flow, preventing the edema .
2. Effects on mobility of soft tissues
Massage has significant effect on the properties of soft tissues.
The tissues which can be effected by massage includes muscles,
sheaths, ligaments, tendons, joint capsules, superficial and deep
fascia.
Subcutaneous scar tissues can be loosened by persistent friction
massage.
Contractures and adhesion formation in muscles and joints can
be stretched and mobilized by pressure manipulation. By this way
massage can maintain and restore mobility of the soft tissues.
3. Effects on Metabolism
Metabolically muscle maintain a chemical balance
through normal activity. When muscle contract they get
rid of toxic products into the lymphatic's and venous flow.
Over activity (Sports, exercise & etc.,)disturbs balance
by not allowing sufficient relaxation time for the inflow of
nutritive product and removal of metabolic waste
products.
The massage (deep stroking) can promote the
disposal of waste products and supply of nutritive material
by assist in lymphatic and venous flow.
4.Effects on excretory system
a) SKIN
The massage improves nutritive states of the skin and it improves
movement of skin over subcutaneous structures. As a result of this the
skin become more soft, pliable and elastic.
The massage activates sweat and sebaceous glands. So that
temperature and healthy skin is maintained
b) KIDNEY
By deep abdominal and lumbar massage stimulates the renal plexus
(which supplies the kidneys). This will result in increased blood supply to
the kidneys and there by it helps in improving functions of the kidney.
5. Effects on respiratory system
The Percussion and Vibration technique of massage
performed over the chest assist in removal of secretion
from the larger airways through their effect on small
airways.
This is because the vibration and percussion technique
will loosen and advances the secretions from the smaller
airways to central airways.
The removal secretions will help in gaseous exchange
( Air entry into the lungs will increase) and thereby it
improves the function of the lungs.
6. Effects of massage on Nervous system
a) On SENSORY nerves
Massage(Superficial stroking)has sedative effect
on the central nervous system.
Massage stimulates the peripheral sensory
receptors mainly touch and pressure receptors
present in the skin and soft tissues.
Massage relieves pain by inducing sedative effect
over sensory nerves.
b) On MOTOR system
Most of the massage techniques stretches the muscle spindle which
facilitate the muscle contraction.
Massage can reduce the muscle spasm by producing inhibitory effect
on motor system.
C) On Autonomic nervous system (ANS)
Massage has a definite reflexive effect and it influence the function of
visceral organ by stimulating the autonomic nervous system.
Physiological responses associated with ANS are heart rate, blood
pressure, respiratory rate, temperature and activity of the sweat glands.
These all function can be influenced by massage.