THERAPEUTIC

MASSAGE
- FOR PHYSIOTHERAPIST

DR. MEGHAN A. PHUTANE (PT)

CARDIORESPIRATORY PHYSIOTHERAPIST
INTRODUCTION
 The word ‘Massage’ comes from the Arabic word
‘mass’ denoting ‘to press’.
 Massage is the scientific manipulation of soft
tissues of body with hands in order to produce
effect on nervous, muscular & circulatory systems
which will help to restore or improve function.
 It is a means used to create energy & is a natural
method of restoring part either locally or generally
injured, to its normal condition.
 Massage demands the skilled use of hands &
brain that comes with practice.
 EFFECTS
OF
MASSAG
E

PHYSIOLOGIC PSYCHOLOGIC
MECHANICAL
AL AL

CENTRAL
CIRCULATORY MUSCULOSKELET
NERVOUS
SYSTEM AL SYSTEM
SYSTEM
MECHANICAL EFFECTS
 Removes dead cells.
 Allows sweat glands, hair follicles & sebaceous glands
to be free of obstruction & function better.
 Increases lubricant effect.
 Increases warmth.
 Used in the treatment of scar tissues & adhesions.
 Promote & retain mobility of new skin tissues.
 Over lungs – frees adherent mucus from bronchial
tree.
 Encourage hyperaemia (due to histamine release) –
increases suppleness of tissues & parasympathetic
activity, relaxes muscle tone, reduces edema,
PHYSIOLOGICAL EFFECTS – CIRCULATORY SYSTEM

 Change in skin color – due to increased circulatory

flow, blood velocity & blood viscosity.
 Effect on BP, HR, skin temperature & conductivity &
oxygen consumption.
 Increased release of histamine from mast cells &
basophills & platelets from blood – initiates triple
response – 1. Dilation of minute blood vessels
2. Flush (flare of redness) around area
3. Slight swelling
PHYSIOLOGICAL EFFECTS – NERVOUS SYSTEM

 Spinal motor neuron excitability of spinal reflex

pathways is reduced due to decreased H-reflex.
 Inhibitory influence on ά motor neuron excitability but
no carryover effect.
 Releases endorphine – reduces chronic pain
PHYSIOLOGICAL EFFECTS – MS SYSTEM
 Affects muscle fatigue
 Affects degree of muscle tone
PSYCHOLOGICAL EFFECTS
 Positive effects on psychological well being
 Increase feeling of relaxation & rest
 Decreases anxiety level & stress hormone level
 Increased levels of immunoglobin A – improves immune
system
 Helps in reducing depression & adjustment disorders
 Improves pain outcomes, mental energy & self rated
health
 Improves sleep outcomes
CONTRAINDICATIONS - ABSOLUTE
 Tissue inflammation / malignancy
 Circulatory disorders (bleeding tendency)
 Abnormal sensations
 Skin disorders
 Early bruising
 Recent, unhealed scars or open wounds
 Adjacent to recent fracture site
 Acute inflammation / tubercular infection of joint & tissue
 h/o or suspected DVT
 Burns
 Advanced osteoporosis
CONTRAINDICATIONS - RELATIVE
 Older people
 Those with fragile skin
 Early stage of osteoporosis
 Children
 Adults with learning &/or physical disabilities
 People recovering from infections & bone #
TREATMENT PLANNING
EXAMINATION OF PATIENT

Assessment

Subjective Objective

History, onset, behavior, nature, Observe & measure the functions

intensity, aggravating & reliving
factors, clinical features
Posture, ROM, activity level, muscle
power, balance, coordination, gait,
Plan objective components ADL, palpation, muscle problem
ASSESSING FINDINGS
 Examination – assess findings – plan treatment
according to indications & contraindications.
CLINICAL REASONING

 Types of clinical reasoning –

 Hypotheticodeductive (form hypothesis)
 Pattern recognition (comes with experience –
integral part)
 Narrative (express in their terms)

 Predictive (estimate outcomes)

DETERMINE INDICATIONS

 Decision to apply massage & to select

particular techniques – based on
examination
 Observation & palpation (tissue response,
end feels)
 Determine nature of tissue glide (eg. Loss of
elasticity – kneeding, picking up; stiffness –
skin rolling)
MEASURING CHANGE & OUTCOME MEASURES
 HR,
 BP,
 RR,
 EMG,
 mood & anxiety measures,
 pain,
 vital capacities,
 joint ROM,
 spasm,
 swelling/ oedema,
 proprioception,
 ADL’s
PALPATION & SKILLS

 Palpation should be repeatable, reliable &

valid.
 Attention to patients & physiotherapist
position, ensuring hands are accurate,
sensitive & testing what is claimed.
 Decide accurately when to apply massage &
when not to apply.
PREPARATION FOR MASSAGE
 Check before starting massage that –
 Reach all the body parts
 Stand in walk or lunge standing
 Change position without hesitation if needed
SELF PREPARATION
 Attention to personal appearance, hygiene & manicure
is important.
 Wear protective clothing (easy laundry, freedom of
movement)
 Restrain long hair, jewelry
 Well care of hands
 Cleanliness (avoid infection) – hand wash before &
after treatment
 Use warm hands
 Maintain ROM of forearm & arm which stretches
(abduction/extension of thumb, flexion/extension of
wrist, pronation/supination)
HAND EXERCISES

 Stretching of fingers
 Abduction of fingers

 Prayer pose

 Reverse prayer pose

RELAXATION
 Relaxation of hands – important to keep in full
contact with patient & mold to the shape of the
body.
 Natural rest position – thumb & fingers slightly
flexed & a little apart
 Relax whole arm – needed for some manipulations
 Practice relaxation prior to learning massage –
good method is reciprocal relaxation
 Co-ordinated & integrated movements of body
without fatigue & physical stress are important.
THE ENVIRONMENT
 Quiet with discreet colors, well heated, well ventilated
 Couch / chair – padded, adjustable, washable covers
 Towels (to cover untreated part), pillows, disposable
paper sheets
CONTACT MEDIUM

 For easy glide – to reduce friction

 Powder (talcum powder/ corn starch)
 Oils (pure lanoline)

 Liquid oils (vegetable oils, liquid paraffin, baby

oil)
 Creams (water based lubricants, soap & water)
ALLERGIC REACTIONS
 Some contact medium might cause mild to severe
allergy
 Check allergic response before use
 Eg. Nut & wheat content
PREPARATION OF PATIENT
 Undress (part to be treated) – free of jwellery
 Upper Limb (neck to fingers)
 Lower Limb (groin to toe)
 Back (head to buttock)
 Neck (head to T12)
 Face (hairline to just below clavicle)
 Keep patient warm
 Position pillows
PALPATION & DEVELOPING SENSORY AWARENESS

 Palpation – skill acquired with practice

 Hands should be clean, warm, relaxed, firm,
comfortable contact.
 Thinking hands (mind investigates structures, felt by
hands, identify structures & become aware of
variations)
 Learn with colleagues – very firm (drill dragging), firm &
very light (butterfly) pressure to different body parts;
palpate for specific anatomical features (arteries, veins,
tendons, muscles, bony prominences)
 Only touch – no tickle
EXAMINATION OF PART
 As described previously
 Look at skin state (dry/ oily/ wet/ hairy) (bruises/
abrasions/ lacerations).
 The feel
TICKLISH SUBJECTS
 Always put hands in very firm contact & never lift
hands off by tackling
 No one hand component (especially fingers)
 Light works tickle, so perform manipulations at
maximum depth as tolerated.
MANIPULATIONS
 MASSAGE
MANIPULATIONS

EFFLURAGE/
PETRISSAGE FRICTION PERCUSSIVE
STROKING
MANIPULATIONS MANIPULATIONS MANIPULATIONS
MANIPULATIONS

* Hacking
* Kneading
* Clapping
* Picking up
* Circular * Vibrations
* Wringing
* Transverse * Beating
* Rolling
*Pounding
* Muscle shaking
* Tapping