Massage

1
Massage

• by
• Vince Lepak, PT, MPH, CWS

2
Objectives

• Students will
• learn the physiological effects of massage.
• differentiate between reflexive and mechanical
  effects of massage.
• understand the effects on range of motion and
  recovery of muscle function after exercise.
• know the various strokes of massage.
• know treatment guidelines for the correct
  implementation of massage.
• This includes indications and contraindications.

3
General Overview
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Reflexive Effects (slide 1 of 2)

• On Pain
• Gate control theory
• Endogenous Opiates release
• On Circulation
• Somatosympathetic reflex - probably does not
  occur with massage, since massage is passive.
• Axonal reflex occurs when cutaneous afferent
  information travels antidromically and produces a
  local vasodilation. (Reed, 1992)

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Axonal reflex (Reed, 1992)

• localized erythema due to the decrease in
  efferent input to the arterioles
• no literature to support or refute this theory

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Reflexive Effects (slide 2 of 2)

• On Metabolism
• Does not alter metabolism significantly. (Lehn
  and Prentice, 1994)
• On Motor Neuron Activity
• There is an inhibition of the spinal motor neuron
  excitability during a massage. It is specific to
  that muscle with no lingering effects. (Morelli,
  Seaborne, Sullivan, 1991 Sullivan, Williams,
  Seaborne, Morelli, 1991 Goldberg, Seaborne,
  Sullivan, Leduc, 1994 and Goldberg, Seaborne,
  Sullivan, 1992)

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Mechanical Effects

• stretching and mobilizing tissues
• mechanically increase blood flow and venous
  return of that muscle. (Lehn and Prentice,1994)

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Circulation

• Light exercise is more effective in increasing
  blood flow than massage. (Tiidus, 1997)
• Cellular metabolism (Guyton Hall, 1996)
• Vasodilator Theory for Local Blood Flow
  Regulation
• Oxygen Demand Theory for Local Blood Flow Control

9
Effects on Range of Motion (ROM)

• Increase ROM short-term, but no Long-term
  effects. (Crosman, Chateauvert, Weisberg, 1984)

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Effects on the Recovery of Muscle Function
(Tiidus, 1997)

• Massage appears to have no benefit on recovery of
  muscle function in the following situations
• muscle damage caused by eccentric overload.
• recovery of post-exercise muscle strength.
• reduction of delayed onset muscle soreness
  (DOMS).
• rate of recovery of muscle function following
  anaerobic work.

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Psychological

• You communicate compassion, concern, anger,
  sensual, or other emotions through touch.

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Different types of strokes

• Effleurage (stroking)
• Superficial or Deep
• Petrissage (kneading)
• Friction
• Transverse or Longitudinal
• Vibration
• Tapotement
• Percussion/slapping/hacking/beating

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Application (slide 1 of 3) (Hunter, 1994)

• Soft Tissue Healing
• Injury
• Protect
• Inflammatory Phase
• Effleurage (Lymphatic) massage
• Light petrissage
• Avoid friction massage

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Application (slide 2 of 3) (Hunter, 1994)

• Fibroblastic-Repair Phase
• Effleurage and petrissage to reduce edema
• Friction to help tension the collagen for proper
  alignment, thus preventing adhesions.
• Maturation-Remodeling Phase
• Patient education
• Pain Cycle

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Pain Cycle
(Weisberg, 1994, p.46)
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Application (slide 3 of 3) (Hunter, 1994)

• Chronic Injury
• Friction
• Petrissage
• Effleurage (lymphatic)

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Good Body Mechanics
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(Fritz, 1995)
19
(Fritz, 1995)
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Indications Contraindications

• Indications
• Patients with adhesions, edema, muscle spasm,
  bursitis, tendinitis, tenosynovitis, strains, and
  sprains.
• Contraindications
• Patients with myositis ossificans, thrombosis or
  embolism, severe varicose veins (caution), acute
  phlebitis, cellulitis, synovitis, abscesses, shin
  injections, and massage of a cancerous site.

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Conclusion
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Effectiveness of Massage

• 1 RCT (Preyde, 2000)
• sub-acute low back pain
• comprehensive massage (25), soft-tissue
  manipulation only (25), remedial exercise with
  education (22), placebo of sham laser (26)
• Outcome measures Roland Disability Questionnaire
  (Q), Sickness Impact Profile, McGill Pain Q
  (Present Pain Index Pain Rating Index), State
  Anxiety Index, Modified Schober test.

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Results

• Roland Disability Q
• Massage Soft-tissue Manipulation showed
  significant improvement in function
• Overall,
• comprehensive massage was the only one to
  maintain statistical significance over the sham
  group on all the outcome measures.

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References (slide 1 of 2)

• Crosman, L. J., Chateauvert, S. R., Weisberg,
  J. (1984). The effects of massage to the
  hamstring muscle group on range of motion.
  Journal of Orthopeadic Sports Physical Therapy,
  6 (3), 168-172.
• Day, J. A., Mason, R. R., Chesrown, S. E.
  (1987). Effect of massage on serum level of
  ß-endorphin and ß-lipotopin in health adults.
  Physical Therapy, 67, 926-930.
• Fritz, S. (1995). Mosbys fundamentals of
  therapeutic massage. St. Louis, MO Mosby.
• Goldberg, J., Seaborne, D. E., Sullivan, S. J.,
  Leduc, B. E. (1994). The effect of therapeutic
  massage on H-reflex amplitude in persons with a
  spinal cord injury. Physical Therapy, 74,
  728-737.
• Goldberg, J., Sullivan, S. J., Seaborne, D. E.
  (1992). The effect on two intensities of massage
  on H-reflex amplitude. Physical Therapy, 72,
  449-457.
• Guyton, A. C., Hall, J. E. (1996). Local
  control of blood flow by the tissues, and humoral
  regulation. In Textbook of medical physiology
  (9th ed., pp. 199-208). Philadelphia, PA W. B.
  Saunders.

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References (slide 2 of 2)

• Hunter, G. (1994, January). Specific soft tissue
  mobilisation in the treatment of soft tissue
  lesions. Physiotherapy, 15-21.
• Lehn, C. Prentice, W. E. (1994). Massage. In
  W. E. Prentice (Ed.), Therapeutic modalities in
  sports medicine (3rd ed., pp. 335-363). St.
  Louis, MO Mosby.
• Morelli, M., Seaborne, D. E., Sullivan, S. J. (
  1991). H-reflex modulation during manual muscle
  massage of human triceps surae. Archives of
  Physical Medicine Rehabilitation, 72, 915-919.
• Preyde, M. (2000). Effectiveness of massage
  therapy for subacute low-back pain a randomized
  controlled trail. Canadian Medical Association
  Journal, 1815-1820.
• Reed, B. V. (1992, Spring). Electrical
  stimulation in circulatory disorders. Physical
  Therapy Practice, 30-40.
• Sullivan, S. J., Williams, L. R. T., Seaborne, D.
  E., Morelli, M. (1991). Effects of massage on
  alpha motoneuron excitability. Physical Therapy,
  71, 555-560.
• Tiidus, P. M. (1997). Manual massage and
  recovery of muscle function following exercise a
  literature review. Journal of Orthopaedic
  Sports Physical Therapy, 25 (2), 107-112.