Massage

PRATIGYA DEUJA- Topic: Massage; Definition, preparation, classification, physiological effects, indication & contradictions

1. topic ------ goniometer MASSAGE PRATIGYA DEUJA

2. DEFINITION M assage is defined as the scientific manipulation done with hands on the soft tissues of the body in order to produce effects on the nervous, muscular and circulating system to improve function.

3. PREPARATION OF MASSAGE SELF PREPARATION : Self preparation by therapist before contacting the patient. Free from hindrance Easy clothing Avoid jewellery Hair tied Stretching- to get good grasp Walk/lunge standing

4. Preparation cont..... 2. PREPARATION OF EQUIPMENT AND ENVIRONMENT: Ventilation A djustable height- towel, couch, pillow Contact material: Talcum powder, olive oil, water based lubricants

5. Preparation cont…… 3 . PREPARATION OF PATIENT: Proper introduction Palpate the area to be massaged so that s/he gets sensory awareness of your touch. Ask patient to undress and cover the part well. Relaxation position.

6. Preparation cont….. 4. PALPATION / EXAMINATION OF PATIENT: Hands should be relaxed Firm contact Fine pressure Touch should not hurt patient nor create the tingling sensation. Look Skin state( dry, hairness , oily, edema) Feel Muscle tension Check Mental condition

7. CLASSIFICATION Stroking : Stroking, Effleurage Petrissage : Kneading, Picking up, Wringing, Shaking, Rolling Friction : Circular, Transverse Percussion/ tapotment : Clapping, Hacking, Vibration, Pounding, Beating, Tapping

8. STROKING Stroking: These are unidirectional manipulation in which operator’s hand pass from proximal to distal. 2 type of effects: stimulative and sedative Effects: Stimulates CNS and can be used in cases of depression. On scalp stimulate hair follicles which increases granular activity and increase hair growth. Slow and deeply helps in relaxation in HTN, recent injuries and spasm.

9. STROKING b) Effleurage : It is unidirectional manipulation. Hands pass through distal to proximal with access of depth performed with palmar surface of whole hand and in small area can use pulp of fingers. The starting fingers exert the pressure.

10. STROKING b) Effleurage : Effects: Increase circulation Edema- increase venous and lymphatic drainage Deep massage- vasodilation of Artery by lubrication of H cells. Improve mobility and elasticity Reflex sedative effect- Reduce muscle tension and pain.

11. PETRISSAGE Kneading: It is a circular manipulation performed so that the skin and subcutaneous tissues moved in circular manner. ( whole kneading, palmar kneading, fingers- flat, tip and pad, thumb- pad & tip, both hands when one superimposed on other, elbow kneading, heel or hand kneading) Pressure in following manner:- 4-10 o’clock, 8-11 o’clock, 6-9 o’clock and 3-6 o’clock Effects -Increase blood supply, - decrease tone, -decrease adhesion, -stretching tight fascia

12. PETRISSAGE b) Picking up: Tissue are compressed within underlying bone, then lifted, squeezed and relaxed. Done with thumb and thenar eminence as one component and medial 2-3 fingers and hypothenar eminence as other compartments. Grasp can be C-shape, V-shape Effects Same as kneading Compression and squeeze will increase drainage.

13. PETRISSAGE c) Wringing: In this manipulation, tissue are compressed against the underlying structures prior to lifting them and once lifted, pull gentle towards yourself with one hand and other side with the fingers at other hand. Alternate movements Smaller areas – tips of finger are used. Effects To lengthen the muscle.

14. PETRISSAGE d) Rolling 2 Types- skin rolling, muscle rolling Skin rolling- Skin is lifted and rolled between the thumb and finger of the hand which are kept parallel to each other and thumb moved towards fingers. Muscle rolling- working across the muscle fibers and along the long axis of muscle. Place both hands on the surface area, move distal from you, palms in full contact with your thumb tips touching and parallel. Pull underlying muscle/skin up apply pressure with your thumb as you adduct and oppose it with rolling. Effects : S ame as picking

15. PETRISSAGE e ) Muscle shaking All long muscle of body is shaken and manipulation is performed. Done on large muscle. Thumb and finger are placed opposite to each other on the muscle palm in and off contact. Then the hand is shaken front side to side. Effects Give a sensory response.

16. FRICTION These are small range, deep manipulation performed in specific anatomical structure with the tips of fingers or thumb, no other part is in contact. 2 types: A) circular B) Transverse

17. FRICTION Circular Performed with finger tips Pressure with small stationary manipulation in circular manner. Can be used on ligaments and myofascial junction.

18. FRICTION B) Transverse The tip of thumb is reinforced by any other tip of finger. Example: Index finger. Place finger across longitudinal axis. Perform friction by moving your digit, hand and forearm in a line parallel to movement. Does not allow movement between your finger and patient’s skin as it can cause pain. Use 2 fingers when long structure is altered, place fingers across the length of collagen. Uses - Inflammation, scar tissue and adhesion

19. TAPOTMENT These are percussive manipulations where we give soft blow with hand. Clapping Whole palmar aspect of the hand is used to strike the body parts. The hand is cupped so that the center doesn’t touch the part, it is in hollow position. Fingers are slightly flexed, the thumb is adducted. The movement of clapping should totally be on the wrist joint, arm movement should not be done. Effects – Slow- greater depth -- Skin stimulator

20. TAPOTMENT B) Hacking Here, we struck skin with the help of dorsal tips of 3 medial finger. The only movement applied to supination and pronation at radio- ulnar joints. Wrist should be in mild extension above 50 degree and fingers in relaxed flexion. Fingers should be 1.5cm away from eachother . 10 strikes/5 seconds are initially imported. Effects Fastly : effects on circular (skin) Slow: Mechanical effect on hollow organ.

21. TAPOTMENT C) Vibration It involves movement in which the tissues are pressed and released using an up and down motion. These can be fine and very coarse. Can be performed by whole hand or finger tips. Our pectorals should alternatively contracted relax. No movements at wrist ,elbow or hand.

22. TAPOTMENT Beating Loosely clenched fist is used for the strike. Fingers are flexed at MCP and PIP joints but extended at DIP joints. Thumb is kept flat. Abduct Arm– allow the wrist to drop in relaxation.

23. TAPOTMENT E) Pounding A bound of hacking with clench fist. Fingers flexed and thumb ties at the lateral side Pronation / Supination F) Tapping Performed with tips of finger pads. Used in small areas. Hand is relaxed and fingers tap slowly to produce hollow hand.

24. PHYSIOLOGICAL EFFECTS On circulatory system: Increase venous flow and lymphatic flow by increasing forward movement of fluid. Increases the arterial flow by stimulating the mast cells Histamine releases Vasodilation Increase blood supply increase oxygen carrying capacity compensation of O₂ demand

25. PHYSIOLOGICAL EFFECTS On metabolic system increase blood flow increase oxygen supply provide proper nutrition supply to the system increase venous/lymphatic flow removal of waste production increase arterial blood flow & venous drainage increases various metabolic activities.

26. PHYSIOLOGICAL EFFECTS c) Nervous system Sensory system Sedative effect with slow rhythm. It reduces pain by stimulating A beta, A delta fibers and bring parasympathetic inhibition. Technique: Effleurage, stroking, hacking, tapping, beating

27. PHYSIOLOGICAL EFFECTS ii. Motor system May reflexly increases the muscle tone by stimulating the skin receptors of stretch spindle. Stroking, tapping, hacking It can reduce tone of muscle if slow stroking is carried out, activation of GTO– inhibit stretch reflex. Deep rhythmic massage is given.

28. PHYSIOLOGICAL EFFECTS iii. ANS It Influences HR, Cardiac output, BP, RR, Skin temperature and work of certain glands. Massage : Increase temperature of skin : Activates sweat gland : Increases skin conductance

29. PHYSIOLOGICAL EFFECTS d) Soft tissue It effects elasticity, plasticity, and mobility It stretches collagen fibers Adhesion broken and maximum mobility. Friction, kneading is used Release muscle tension by releasing plasma myoglobins and working on GTO. Relives pain in soft tissue. Provides relaxation of soft tissues by increasing the circulation and fulfilling oxygen demand.

30. PHYSIOLOGICAL EFFECTS Effect on skin Facilitate movement of skin over subcutaneous structures. Skin becomes soften, supple and later makes it more elastic over adipose tissue. Removes deposited adipose tissue. Psychological effects Lower the psychoemotional and somatic arousal such as anxiety and tension.

31. INDICATION Edema- Relived with elevation and massage. Radial mastectomy- Facilitates the lymphatic drainage and relieves pain and congestion. Venous ulcers- decrease edema, increase circulation and mobilize soft tissue LMN lesion- Massage facilitate stretch reflex and enhances the absorption of tissue fluid. Bell’s palsy- maintains elasticity of the muscle and improves circulation. sprain

32. INDICATION 7. Tenosynovitis - Massage restore range and increase mobility 8. Tendinitis/ Sprain- can regain mobility by breaking scar and relieve pain 9. Removal of secretion from Respiratory system 10. Decrease pain

33. CONTRADICTIONS GENERAL LOCAL High fever Severe renal or cardiac diseases Deep x-ray therapy Osteoporosis Severe spasticity Very hairy skin Acute inflammation Skin disorder Recent fracture Severe varicose vein Atherosclerosis Thrombosis Myositis ossificans Malignancy Open wound