... of Massage ... depending on method utilized, pressur

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Therapeutic Sports Massage

Jennifer Doherty-Restrepo, ATC, LAT Entry-Level
Athletic Training Education Program PET 4995
Therapeutic Modalities
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Physiologic Effects of Massage

• Mechanical stimulation of tissues by rhythmically
  applied pressure and stretching
• Effects of massage may be either
• ___________, or
• ___________
• Effects differ depending on method utilized,
  pressure exerted, and duration of massage

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Physiologic Effects of Massage

• ___________
• Effects sensory and motor nerves locally
• Elicits some central nervous system response (ie
  sedation)
• ___________
• Makes mechanical or histological changes in
  myofascial structures through direct force
  applied superficially

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Reflexive Effects

• Attempts to exert effects through ______ and
  superficial connective tissues
• Contact stimulates _________ receptors
• Reflex mechanism is believed to be an autonomic
  nervous system phenomenon
• The reflex stimulus causes
• Sedation,
• Relieves tension, and
• Increases blood flow

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Reflexive Effects cont.

• Effects on Pain
• Modulates pain through Gate Control
  ?-Endorphins theories
• Effects on Circulation
• Increases blood and lymphatic flow
• Effects on Metabolism
• Does not alter general metabolism
• Increases fresh blood and oxygen to area
• Assists in removal of lactic acid

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Mechanical Effects

• Techniques which stretch a muscle, elongate
  fascia, or mobilize soft tissue
  adhesions/restrictions
• Always accompanied by some reflex effects
• As mechanical stimulus becomes more effective,
  reflex stimulus becomes less effective
• Directed at deeper tissues, such as adhesions or
  restrictions in muscle, tendons, and fascia.

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Mechanical Effects

• Effects on Muscle
• Mechanical stretching of intramuscular connective
  tissue to relieve pain and discomfort associated
  with myofascial trigger points
• Increases blood flow to skeletal muscle
• Slows muscle atrophy following injury
• Increases range of motion
• Does not increase strength or muscle tone

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Mechanical Effects cont.

• Effects on Skin
• Increases skin temperature
• Increases sweating
• Decreases skin resistance to galvanic current
• Mechanically loosens adhesions and softens scar
  tissue
• Stretches and breaks down fibrous scar tissue
• Breaks down adhesions between skin and
  subcutaneous tissue

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Psychologic Effects of Massage

• Psychologic effects of massage can be as
  beneficial as physiologic effects
• ___________" modality where patients feel as if
  someone is helping them

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Treatment Considerations and Guidelines

• Knowledge of ___________ is essential
• Understanding of existing pathology
• Thorough knowledge of massage principles

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Positioning of Clinician

• Prevent ___________
• Permit free movement of
  arms, hands, and body
• Evenly distribute weight by shifting from
  one foot to
  the other
• Fit your hands to the
  contour of area being
  treated
• Hands should be clean, warm, dry, and soft

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Treatment Techniques

• Pressure regulation
• Determined by the type and amount of tissue
  present and patient's condition
• Rhythm
• Must be steady and even
• Strokes should overlap
• Duration
• Depends on the pathology, size of the area being
  treated, speed of motion, age, size, and
  condition

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Treatment Techniques

• Swelling
• Begin proximally to facilitate lymphatic flow
• ___________
• Body part may be elevated if necessary
• Direction of forces should parallel muscle fibers
  
• Make sure patient is warm and in a comfortable,
  relaxed position
• Massage should never be ___________

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Treatment Techniques

• Sufficient lubricant should be used
• Begin with superficial stroking to spread
  lubricant
• Begin and end with ___________
• Pressure should be in line with venous flow
  followed by a return stroke

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Equipment Set Up

• Table
• Linens and pillows
• Lubricant
• Should be absorbed
  slightly by skin but
  
  does not make it slippery
• Combination of one part beeswax to three parts
  coconut oil
• Other types of lubricants that may be used are
  olive oil, mineral oil, cocoa butter,
  hydrolanolin, analgesic creams, alcohol, and
  powder

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Preparation of Patient

• Patient should be in a relaxed, comfortable
  position
• Part involved in treatment must be adequately
  supported
• Prone, supine, seated
• Patient should appropriately draped

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Hoffa Massage

• Classical massage technique which uses a variety
  of superficial strokes
• Effleurage
• Petrissage
• Tapotment
• Vibration

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Effleurage

• Any stroke that glides over skin without
  attempting to move deep muscles
• Hands are molded to treatment area
• Apply constant pressure moving toward _______
• Lighter pressure applied on the return stroke

Every massage begins and ends with effleurage!
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Effleurage cont.

• Moderate pressure according to patient and
  condition
• Deep stroking is a form of effleurage, except it
  is given with more pressure to produce a
  mechanical effect
• Increases venous and lymphatic return
• Increases circulation to skin surface

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Petrissage

• Kneading manipulations
• Muscles are gently lifted, rolled, and released
• Pressure is applied intermittently
• Hands may remain stationary or move along length
  of muscle or limb

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Petrissage cont.

• Increases venous and lymphatic return
• Removes metabolic waste products
• Breaks up adhesions between skin and underlying
  tissue

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Tapotment

• Percussion massage
• Series of rapid, brisk blows
• Increases circulation and blood flow
• Stimulates peripheral nerve endings

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Tapotment cont.

• Hacking

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Tapotment cont.

• Hacking
• Slapping

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Tapotment cont.

• Hacking
• Slapping
• Beating

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Tapotment cont.

• Hacking
• Slapping
• Beating
• Tapping

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Tapotment cont.

• Hacking
• Slapping
• Beating
• Tapping
• Clapping or cupping

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Vibration

• Shaking massage
• Tremulous movement made by hand or fingers placed
  firmly against a body part
• Rhythmical trembling movement will come from
  ___________
• Hands should remain in contact with the body part

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Transverse Friction Massage

• Technique used for treating chronic tendon
  inflammation or connective tissue adhesions
• Stimulates ___________ ___________ to progress
  healing process
• Apply small circular motions penetrating to
  deeper tissues
• Apply strong pressure in ___________ direction to
  fibers for 7 to 10 minutes every other day

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Acupresure and Myofascial Trigger Point Massage

• Acupressure points are based on ancient Chinese
  art of acupuncture
• Myofascial trigger points found in
• Muscle and tendon myofascia
• Ligaments and capsules surrounding joints
• Periosteum
• Acupressure points and myofascial trigger points
  are similar

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Acupresure and Myofascial Trigger Point Massage

• Pain results due to inflammatory response
  following direct trauma or overuse
• Pain usually referred to areas which follow a
  specific pattern
• Stimulation of these points has been demonstrated
  to result in pain relief

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Acupressure Massage Techniques

• Locate points from chart
• Use fingers, or elbow, to apply
  small friction-like circular motions
• Amount of pressure applied should be
  intense and
  painful
• Patient reports a dulling
  or numbing effect
• Treatment times range from 1-5 minutes at several
  points

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Myofascial Release

• Also called soft tissue mobilization
• Techniques used to relieve soft tissue from
  abnormal grip of tight fascia
• Myofascial restrictions are unpredictable and may
  occur in many different planes and directions
• Based on localizing restriction and moving into
  the direction of the restriction
• Myofascial manipulation is subjective and relies
  heavily on the experience of the clinician

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Myofascial Release Technique

• Protecting the clinicians hands
• Use fist or elbow if necessary
• Use limited lubricant
• Avoid slipping of hands on the skin
• Positoning of the patient is critical
• Maximize effects of treatment

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Indications For Massage

• Increase coordination
• Decrease pain
• Decrease neuromuscular excitibility
• Stimulate circulation
• Facilitate healing
• Restore joint mobility
• Remove lactic acid

• Alleviate muscle cramps
• Increase blood flow
• Increase venous return
• Retard muscle atrophy
• Increase range of motion
• Edema
• Myofascial trigger points
• Stretching scar tissue

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Indications For Massage

• Adhesions
• Muscle spasm
• Myositis
• Bursitis
• Fibrositis
• Tendinitis

• Revascularization
• Raynaud's disease
• Intermittent claudication
• Dysmenorrhea
• Headaches
• Migraines

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Contraindications For Massage

• Arteriosclerosis
• Thrombosis
• Embolism
• Severe varicose veins
• Acute phlebitis
• Cellulitis

• Synovitis
• Abscesses
• Skin infections
• Cancers
• Acute inflammatory conditions