Techniques & Conditions Review TECHNIQUES

1.

Effleurage:
Used to address and effect circulation. Moves blood and lymph on a superficial level and warms the tissue in two ways (1) (2) Skin on skin contact increases heat Increased circulation makes the tissue more supple and therefore prepares it for deeper work Considered the technique used to ease or lengthen a spasm because it is the least invasive or jarring. Considered a technique that glides pressure is applied evenly through entire stroke. Pressure can deepen with each successive stroke. Considered a diagnostic stroke. Effleurage may be referred to on exam as: Gliding, Stroking, Bi-lateral Tree, Shingles

2.

Petrissage:
Also designed to address and effect circulation. It does everything Effleurage does but does it at a deeper level. Designed to effect muscle bellies. Mimics the action of skeletal muscle contraction. Petrissage is like putting water on a dry sponge. By filling the muscle with fluid (blood) it becomes soft and pliable (like the sponge). The warmth of the blood also adds to pliability. Bringing warm fluid to area makes it ready for deeper work. Then you are able to either work through the tissue itself, or pick it up and move it out of the way to work underneath the tissue. Increased circulation to the area clears waste product from tissue the focus is on the muscle belly Petrissage may be referred to on exam as: Chucking, Milking, Rolling, Wringing, Kneading

3.

Friction:
Mechanical technique utilizing, finger, thumb, knuckle, tool etc. to destroy adhesions by locating stuck tissue of any combination of muscle, bone, fascia etc. and breaking it down. GIVES TISSUE THE POTENTIAL FOR MOVEMENT Used around joints and along bony surfaces it is considered a technique to regain mobility. Produces local hyperemia. Increase in circulation is warm fluid and increases the mobility potential. Increased circulation is a by-product of the technique but not the primary motive. Friction may be referred to on exam as: Parallel Friction, Circular Friction, and Longitudinal Friction etc.

4.

Vibration & Tapotement:

Considered the least used Swedish massage Vibration addresses and affects the nervous system Tapotement addresses and affects the skeletal muscle. Length of time the technique is applied determines the physiological effect In a local fixed area, vibration and/or tapotement effects: 0 10 seconds 10-60 seconds Stimulates the tissue Calms, relaxes, sedates, soothes, eases etc.

60 seconds or more Exhausts the tissue (good for hypertonic muscles i.e. lower back muscles lordosis)

5.

Heat & Cold

Hot Pack Dilates blood vessels Max Temp 110 Cold Pack Constricting to blood vessels 32 - 55 considered a cold pack

6.

Exercise:
Passive: Therapist moves the client, client does nothing Passively stretches the tissues Breaks down adhesions deep in the joint that the massage therapist cannot reach There is more ROM with PROM than AROM

Active: Massage Therapist tells client, what to do and the client does it. Builds Muscle strength Moves circulation

Resisted: Active movement with resisted action Builds Muscle strength

7.

Contraindications/Precautions/Cautions
1st step is to determine if contraindications are present by asking the client questions about current state and medical conditions.

General Contraindications: Fever Systemic or Infective puss, acute rheumatoid arthritis, cancerous tumors

Abdominal Massage Contraindications: Women having their period Bleeding Ulcer High Blood Pressure

Local Contraindications Varicose Veins (can work around them to increase collateral circulation) Broken Skin

 Bedsores caused by lack of circulation move gentle circulation towards the wound area without disturbing (do NOT shift the skin of the wound) the center of the wound produce local hyperemia vibrate around are while gauze is domed over the bedsore the vibration flutters through the wound and stimulates the fibroblasts a.k.a. also called decubitous ulcers

8.

Other Names to Know

Question contains Bindegeswebbmassage Answer Other Info Elizabeth Dickie applied to connective tissue between the skin & the muscle (fascia) dermatomes

Trigger Point Therapy

Janet Travel

TPs are areas of hyperirritability can be in bone, muscle, fascia etc. Satellite TPs & referred pain twitch/jump response

James Cyriax

Transverse Friction

CONDITIONS
1.

Acute v. Chronic
Acute Phase goal: decrease swelling The longer swelling is present the more adhesions develop. Toxins in immobilized area settle. The less the solutions hovers, the less adhesions. Elevate Circulation strokes proximal to distal (effleurage & petrissage) Ice Chronic Phase goal: increase mobility Friction & PROM

2.

Tendonitis
Irritant is triggering tendon, repetetive use. It is an ongoing low-level irritant so there is no real acute phase. Chronic Tx Friction realigns fibers and reduces adhesion Address misrecruitment of Muscles Massage Therapist needs to aid in breaking of substitution habits due to muscle disuse Ice to counter irritation of tendon because of friction tx CAUTION during PROM is overstretching Rehab Exercises: Eccentric contraction is easier and the best way to start point for rehab

3.

Traumatic Injuries
Example: Ankle Sprain - Inversion sprain is the most common First question to ask is Have you had an x-ray? must confirm no fractures before treatment Acute Tx (lots of swelling) Elevate Ice Proximal/distal circulation massage Chronic Tx (adhesions & lack of mobility) Friction - creates potential for movement PROM increases mobility Exercises PROM 1. 2. 3. Dorsi & Plantarflexion Eversion Inversion (last because peroneals compromised)

RIT increases mobility Eversion last because peroneals compromised

4.

Fractures
Example: Colles Fracture Tx Immobilize Wrist (cast) Elevate Proximal & some distal circulation massage (work areas exposed on both ends of cast) Maintain muscle tone while in cast (i.e squeeze ball for flexors, extend fingers against rubberband for extensors) this is a pumping action which will lessen atrophy and adhesions pumps circulation which is good for all healing After cast is removed Initially circulation strokes and PROM with exercises increase atrophied muscle tone Exercises 1. Easiest movements first - Flexion & Extension of the wrist (w/soup can eccentric contraction) 2. 3. Radial & Ulnar deviation (PROM & RIT) Pronation (PROM & RIT)

When muscle tone returns, start friction to adhesions

5.

Deformities of the spine

Example: Kyphosis, Lordosis, Scoliosis Treat shortened muscles first

6.

Neuralgias/Neuritis
a. Example: Bells Palsy impacts CN VII - commonly sat under a draft and the nerve is irritated, of the face becomes flaccid Note: Be careful with flaccid tissue, as tissue is non-responsive. A minimal amount of work can exhaust the tissue.

Treatment: Short bursts of work (30 seconds) in an upward direction. i.e. light fingertip tapotement, short effective petrissage in upward direction Work elsewhere for 3 minutes or more Short bursts of work (30 seconds) in an upward direction move on, repeat etc. Rehabilitation Have client cover unaffected side of face w/a piece of paper and look in the mirror. Have client work affected side by trying to smile, speak, make vowels & facial expressions. The covering of the unaffected side enables the client to notice any small changes on the affected side. This acknowledgement works as positive reinforcement. b. Impingement/Entrapment on nerve plexus Example: Brachial Neuralgia - Nerve pain response is to contract in splint/spasm this increases compression creating pain/spasm/pain cycle - if at all possible go to the original site of problem i.e. if it is a contracted muscleTx Slacken the contracting muscle Work in slackened position to alleviate pressure on plexus Soften splinting muscle Sciatica if cause is a herniated disc, you can not treat this but can work reponding muscle Pregnancy if nerve entrapment is baby pressing on nerve, have woman go on all fours so the baby will float and alleviate pressure Other Tx Confuse the muscle with jostling at random arbitrary movement patterns i.e ruddering of femur by flexing knee, holding ankle, occasionally sneak in a stretch

7.

Flaccid/Spastic Paralysis note tissue is not normal tissue

(1) Flaccid Immediately start PROM, effleurage and petrissage

 Say it, show it, imagine it client should receive multisensory input during rehabilitation as many ways as possible to keep the neuromuscular connection Gentle movement Short bursts the muscle is easily exhausted minimize PROM (2) Spastic Random movments to confuse/shift neuromuscular pattern When the muscle quiets gentle PROM Then soften spastic muscles (3) Amputee Sever the neuromuscular pathway Get patient to look at the stump & handle it Lots of tapotement at stump short bursts NOT to the point of exhausting the muscle

8.

Respiratory Drainage
Example: Cystic Fibrosis Prone: Head of table lower than feet Sputum cup, bucket w/disinfectant, tissues & garbage pail Tapotement over lungs spit tapote spit etc.