Therapeutic massage

Massage of therapeutic form is beneficial in many conditions like stroke, flaccidity, muscle tightness, spasm etc.
it has many physiological effects along with many types for different conditions as well as different body areas.

1. Presented By :- Presented By :-
RADHIKA RADHIKA
CHINTAMANICHINTAMANI

2. CONTENTSCONTENTS

DefinitionDefinition

Introduction & HistoryIntroduction & History

TypesTypes

Relevant anatomy and physiologyRelevant anatomy and physiology

Effects of therapeutic massageEffects of therapeutic massage

Application techniques: assessment and Application techniques: assessment and
treatmenttreatment

IndicationsIndications

ContraindicationContraindication

3. DefinitionDefinition

““Massage is the term used to express certain scientific Massage is the term used to express certain scientific
manipulations, which are performed by the hands of the operator manipulations, which are performed by the hands of the operator
upon the body of the patient. It is a means used for creating energy, upon the body of the patient. It is a means used for creating energy,
where such has become exhausted , from whatsoever cause and is a where such has become exhausted , from whatsoever cause and is a
natural method of restoring the part either locally or generally natural method of restoring the part either locally or generally
injured, to its normal condition.”injured, to its normal condition.”
Massuse’s Pcketbook (1907)Massuse’s Pcketbook (1907)

““The scientific manipulation of the soft tissues of the body apart The scientific manipulation of the soft tissues of the body apart
from mere rubbing.” from mere rubbing.”
Prosser (1941)Prosser (1941)

““Technically it can be described as therapeutic manipulation of soft Technically it can be described as therapeutic manipulation of soft
tissue.”tissue.”
Vickers (1996)Vickers (1996)

4. Introduction & HistoryIntroduction & History

The word massage comes from ‘mass’ the Arabic term denoting ‘to The word massage comes from ‘mass’ the Arabic term denoting ‘to
press’.press’.

Massage is used therapeutically since ages by many civilization from Massage is used therapeutically since ages by many civilization from
5000 years ago.5000 years ago.

Almost all civilizations like: Hindus of India, Chinese, Japanese, the Almost all civilizations like: Hindus of India, Chinese, Japanese, the
Thai, ancient Egyptians, Greeks and Romans.Thai, ancient Egyptians, Greeks and Romans.

Hippocrates described its medical uses as well.Hippocrates described its medical uses as well.

Massage played an important role in Roman Bath concept as well.Massage played an important role in Roman Bath concept as well.

5. TypesTypes

There are various types of massages like;There are various types of massages like;
A.A.Western forms of massage.Western forms of massage.
B.B.Shaitsu: a modern form of accupunctureShaitsu: a modern form of accupuncture
C.C.Tui-na: a form of accupressureTui-na: a form of accupressure
D.D.Anma (amma): Japanese massageAnma (amma): Japanese massage
E.E.Ayurvedic massageAyurvedic massage

6. Relevant anatomyRelevant anatomy
THE SKIN:
Functions:
1.Protection from dehydration,
chemicals, UV rays, trauma
2.Regulation of temperature in
order
3.Has various sensory nerve
endings: nociceptors, ruffini’s
corpuscles, pacini’s corpuscles,
Merkle’s disc, Meissner’s discs
4.Excretion of excess fluids
5.Production of Vitamin D
6.Absorption of drugs and some
other substances such as
essential oils
7.For immunity by acting as
barrier

7. Effects of Therapeutic MassageEffects of Therapeutic Massage
1.1.Mechanical effectsMechanical effects

This effects is seen due to constant passage of hands over the This effects is seen due to constant passage of hands over the
skin which removes dead surface cells and allows the sweat skin which removes dead surface cells and allows the sweat
glands, the hair follicles and the sebaceous glands to be free of glands, the hair follicles and the sebaceous glands to be free of
obstruction and to function better.obstruction and to function better.

The increased lubrication effect is seen in subjects with The increased lubrication effect is seen in subjects with
desquamationdesquamation

Used in management of scars by inducing space; thus loosening Used in management of scars by inducing space; thus loosening
up the adhesion and inducing scar tissue mobilisation.up the adhesion and inducing scar tissue mobilisation.

8. Effects of Therapeutic MassageEffects of Therapeutic Massage
2. Physiological effects2. Physiological effects
A.A.Circulatory effects: Circulatory effects:

Initial capillary constriction occurs in response to light pressure Initial capillary constriction occurs in response to light pressure
seen as a transient white lineseen as a transient white line

Skin rolling a form of therapeutic massage release a histamine Skin rolling a form of therapeutic massage release a histamine
related substancerelated substance

Massage helps to increase circulation of the skin due to intermittent Massage helps to increase circulation of the skin due to intermittent
pressure applied and relieved during massage.pressure applied and relieved during massage.

Increased lymphatic drainageIncreased lymphatic drainage

Improved venous return to heartImproved venous return to heart

9. B. Effects on nervous system: B. Effects on nervous system:

Slow rhythmic stroking: gives relaxation effectSlow rhythmic stroking: gives relaxation effect

Fast stroking gives: excitatory effectFast stroking gives: excitatory effect

Deep massages: relaxation/inhibitory effectDeep massages: relaxation/inhibitory effect
C. Effects on Pain:C. Effects on Pain:

Pain caused due to muscles under spasm, tightness: slow and deep Pain caused due to muscles under spasm, tightness: slow and deep
massagemassage

Pain due to irritation of muscle in acute stages like muscle tear: Pain due to irritation of muscle in acute stages like muscle tear:
massage is contraindicatedmassage is contraindicated

Pain due to muscular pressure on nerves: Radiculopathy: deep massage Pain due to muscular pressure on nerves: Radiculopathy: deep massage
along the neuromuscular interface till the end point of radiating pain.along the neuromuscular interface till the end point of radiating pain.

10. D. Effects on Musculoskeletal system: D. Effects on Musculoskeletal system:

Slow deep massage: Reducing tone in spasmodic muscles Slow deep massage: Reducing tone in spasmodic muscles

Quick stroking massage: Improving tone in flaccid muscleQuick stroking massage: Improving tone in flaccid muscle

Constant deep massage: Improves the flexibility as well as extensibility of the muscleConstant deep massage: Improves the flexibility as well as extensibility of the muscle

Helps in relaxationHelps in relaxation
E. Effects on Psychological system:E. Effects on Psychological system:

Massage helps in relieving tension/anxious moods by inducing somatic arousal and Massage helps in relieving tension/anxious moods by inducing somatic arousal and
reducing tension with the muscle indirectly reducing anxiety in subjects.reducing tension with the muscle indirectly reducing anxiety in subjects.

Increase in sympathetic activityIncrease in sympathetic activity

Pain caused due to muscles under spasm, tightness: slow and deep massagePain caused due to muscles under spasm, tightness: slow and deep massage

Pain due to irritation of muscle in acute stages like muscle tear: massage is contraindicatedPain due to irritation of muscle in acute stages like muscle tear: massage is contraindicated

Pain due to muscular pressure on nerves: Radiculopathy: deep massage along the Pain due to muscular pressure on nerves: Radiculopathy: deep massage along the
neuromuscular interface till the end point of radiating pain.neuromuscular interface till the end point of radiating pain.

11. Application techniques: Application techniques:
A. AssessmentA. Assessment

Assessment of part to be Assessment of part to be
massaged is done by following massaged is done by following
methods:methods:
i.i.ObservationObservation: :
Postural evaluationPostural evaluation: :
Observation of each bony Observation of each bony
landmark or joint and its landmark or joint and its
position with respect to position with respect to
contralateral side. Eg for contralateral side. Eg for
dysfunction: pectoralis dysfunction: pectoralis
tightness: shoulder goes into tightness: shoulder goes into
protraction which is viewed as protraction which is viewed as
protracted shoulder in lateral protracted shoulder in lateral
view posture analysis.view posture analysis.

12. A. Assessment Continued.. A. Assessment Continued..
-Observe during movements: Observe during movements:
for any muscular tightness for any muscular tightness
while performing movement. while performing movement.
Eg: compare the angle of Hip Eg: compare the angle of Hip
flexion with knee extension flexion with knee extension
in supine: if one leg is of less in supine: if one leg is of less
angle actively and reaches to angle actively and reaches to
equal angle when done equal angle when done
passively; indicates tightness. passively; indicates tightness.
Respective to the angle Respective to the angle
various muscles are tight.various muscles are tight.Angles of hip flexion and pain occurring varies with the type of dysfunction.
a.0-30: hip joint pain
b.30-70: sciatica: Massage is sometimes used to treat
c.70-120: hamstring muscle dysfunction: Massage is used to treat
d.120 and above: SI joint pain

Angles of hip flexion and pain occurring varies with the type of dysfunction.
a.0-30: hip joint pain
b.30-70: sciatica: Massage is sometimes used to treat
c.70-120: hamstring muscle dysfunction: Massage is used to treat
d.120 and above: SI joint pain

13. ii.ii.Palpation: there are various soft Palpation: there are various soft
tissue palpation techniques, used tissue palpation techniques, used
to assess the muscle turgour. to assess the muscle turgour.
These techniques involve These techniques involve
superficial and deep palpationsuperficial and deep palpation
A.A.Flat palpation technique: for Flat palpation technique: for
flatter muscles and more flatter muscles and more
superficially located onessuperficially located ones
B.B.Snapping palpation technique: for Snapping palpation technique: for
cord like structures which are cord like structures which are
deeply locateddeeply located
C.C.Pincer grasp: for superficial bulk Pincer grasp: for superficial bulk
like biceps brachiilike biceps brachii

14. B. Massage manipulation B. Massage manipulation
techniquestechniques
There are various types of technique performed differently There are various types of technique performed differently
also used for different conditions: also used for different conditions:
1.1.EffleurageEffleurage
2.2.PetrissagePetrissage
3.3.MF TrP TherapyMF TrP Therapy
4.4.RollingRolling
5.5.StrokingStroking
6.6.Deep tissue massageDeep tissue massage

15. 1.1.EffleurageEffleurage

It is a unidirectional manipulation in which the practitioners It is a unidirectional manipulation in which the practitioners
hand passes from distal to proximal with a depth compatible hand passes from distal to proximal with a depth compatible
with the state of the tissues and the desired effect.with the state of the tissues and the desired effect.

Manipulation usually starts at one end and proceeds Manipulation usually starts at one end and proceeds
proximally, thus draining the part underneath.proximally, thus draining the part underneath.

Aims: Aims:
i.i.Assists venous and lymphatic drainageAssists venous and lymphatic drainage
ii.ii.Assists fluid interchangeAssists fluid interchange
iii.iii.Assists in relaxation of the subject due to sedative effectAssists in relaxation of the subject due to sedative effect
iv.iv.Helps in decreasing or increasing muscle tone.Helps in decreasing or increasing muscle tone.
v.v.Passively stretches the fibers.Passively stretches the fibers.

16. 
Subjects position: relaxed Subjects position: relaxed
position of the part to be position of the part to be
treated.treated.

Therapists position: Step Therapists position: Step
standingstanding

Hand position: Performed Hand position: Performed
with whole hand, softly with whole hand, softly
curved and relaxed to fit curved and relaxed to fit
the part, should be placed the part, should be placed
obliquely on the skin. Both obliquely on the skin. Both
hands can also be used to hands can also be used to
treat.treat.

17. 2. Stroking2. Stroking

It is a unidirectional manipulation in which the practitioners It is a unidirectional manipulation in which the practitioners
hand passes usually from proximal to distal down the length hand passes usually from proximal to distal down the length
of the tissues at speed compatible with the desired effect. The of the tissues at speed compatible with the desired effect. The
direction of stroking may be varied to give greater comfort. direction of stroking may be varied to give greater comfort.
The depth of the stroking is minimal in order to induce The depth of the stroking is minimal in order to induce
relaxation/stimulating. relaxation/stimulating.

Aims: Aims:
i.i.Assists in creating sedative effect (slow): one stroke per 5 Assists in creating sedative effect (slow): one stroke per 5
secondsseconds
ii.ii.Assists in creating a stimulating effect (fast): four strokes per Assists in creating a stimulating effect (fast): four strokes per
5 seconds5 seconds

18. 
Subjects position: relaxed position Subjects position: relaxed position
of the part to be treated.of the part to be treated.

Therapists position: Step standingTherapists position: Step standing

Hand position: stroke should start Hand position: stroke should start
with a firm contact and finish with with a firm contact and finish with
a smooth lift off of hands. The hand a smooth lift off of hands. The hand
can be positioned obliquely so that can be positioned obliquely so that
heel travels first, but application is heel travels first, but application is
only by the finger tips.only by the finger tips.
i.i.One hand: narrow area like thighsOne hand: narrow area like thighs
ii.ii.Two hands: broader area like backTwo hands: broader area like back
““Thousand hands technique”Thousand hands technique”
One hand performs a short stroke, the One hand performs a short stroke, the
second hand does pass over one second hand does pass over one
another to gain contact as the another to gain contact as the
manipulation proceeds down the length manipulation proceeds down the length
of the part under treatmentof the part under treatment

19. 3. Petrissage3. Petrissage

It is a type of massage manipulation in which the soft tissues It is a type of massage manipulation in which the soft tissues
are compressed either against underlying bone or against are compressed either against underlying bone or against
themselves.themselves.

Aims: Aims:
i.i.Assists venous and lymphatic drainageAssists venous and lymphatic drainage
ii.ii.Assists fluid interchangeAssists fluid interchange
iii.iii.Increases mobility of underlying tissueIncreases mobility of underlying tissue
iv.iv.Has an effect on somatovisceral reflexesHas an effect on somatovisceral reflexes

20. 
Petrissage are divided into:Petrissage are divided into:
I.I.KneadingKneading
II.II.Picking up manipulationPicking up manipulation
III.III.WringingWringing
IV.IV.RollingRolling
V.V.Shaking Shaking

21. I. KneadingI. Kneading

It is a type of circular manipulation performed so that the It is a type of circular manipulation performed so that the
skin and subcutaneous tissue are moved in a circular manner skin and subcutaneous tissue are moved in a circular manner
on the underlying structures.on the underlying structures.

The circle is described by the part of your hand in contact.The circle is described by the part of your hand in contact.

The actual range or number of degrees for which pressure is The actual range or number of degrees for which pressure is
exerted varies with the part to be treated.exerted varies with the part to be treated.

22. 
Subjects position: relaxed position Subjects position: relaxed position
of the part to be treated.of the part to be treated.

Therapists position: Stride standingTherapists position: Stride standing

Hand position: performed with;Hand position: performed with;
-Whole hand kneadingWhole hand kneading
-Palmar kneadingPalmar kneading
-With fingers only: flat finger With fingers only: flat finger
kneading, finger pad kneading and kneading, finger pad kneading and
finger tip kneading.finger tip kneading.
-With the thumb: thumb pad With the thumb: thumb pad
kneading and thumb tip kneadingkneading and thumb tip kneading
-Both hands when one is Both hands when one is
superimposed on the othersuperimposed on the other
-Double handed: alternatively or Double handed: alternatively or
simultaneouslysimultaneously

23. II. Picking UpII. Picking Up

It is a type of manipulation in which tissues are compressed It is a type of manipulation in which tissues are compressed
against underlying bone, then lifted, squeezed and released.against underlying bone, then lifted, squeezed and released.

The manipulation is often performed single handed with sthe The manipulation is often performed single handed with sthe
thumb and thenar eminence as one component and the thumb and thenar eminence as one component and the
medial two or three fingers and hypothenar eminence as the medial two or three fingers and hypothenar eminence as the
other component of the grasp.other component of the grasp.

Types of grasp:Types of grasp:
A.A.‘‘C’- shaped grasp: for wider or larger areasC’- shaped grasp: for wider or larger areas
B.B.‘‘V’-shaped grasp: for narrower areas.V’-shaped grasp: for narrower areas.

24. 
The cleft between the thumb and index finger should always The cleft between the thumb and index finger should always
be in contact with the subjects skin, otherwise it has a be in contact with the subjects skin, otherwise it has a
pinching effect and the depth of massage is lost.pinching effect and the depth of massage is lost.

The technique is performed with arms held in slight The technique is performed with arms held in slight
abduction and elbows semi-flexed.abduction and elbows semi-flexed.

25. III. WringingIII. Wringing

It is a type of It is a type of
manipulation in which manipulation in which
tissues are compressed tissues are compressed
against underlying against underlying
structures, then, pull structures, then, pull
them with one hand them with one hand
while pushing them in while pushing them in
the prior mentioned the prior mentioned
direction with the thumb direction with the thumb
of opposite hand.of opposite hand.

Basically the structure to Basically the structure to
be treated is wringed be treated is wringed
between two handsbetween two hands

It is a type of It is a type of
manipulation in which manipulation in which
tissues are lifted and tissues are lifted and
rolled between thumbs rolled between thumbs
and fingers of the two and fingers of the two
hands. hands.

Two types:Two types:
A.A.Skin rolling: performed Skin rolling: performed
on back, abdomen, on back, abdomen,
thighs, knees and on scar thighs, knees and on scar
tissues.tissues.
B.B.Muscle rolling: Muscle rolling:
performed by working performed by working
along the long axis of the along the long axis of the
muscle and fiber muscle and fiber
orientation orientation
IV. RollingIV. Rolling

26. 
Skin rollingSkin rolling

Muscle rollingMuscle rolling
WringingWringing RollingRolling

27. V. Muscle shakingV. Muscle shaking

Long bellies may be shaken and Long bellies may be shaken and
muscle manipulation can be muscle manipulation can be
performed on the larger muscles performed on the larger muscles
likes: biceps brachii, triceps likes: biceps brachii, triceps
brachii, quadriceps, gastrocnemius brachii, quadriceps, gastrocnemius
and also on the small muscles of and also on the small muscles of
thenar and hypothenar eminences.thenar and hypothenar eminences.

Movement of the model is Movement of the model is
sideways and involves rapid radial sideways and involves rapid radial
and ulnar deviation of the wrist.and ulnar deviation of the wrist.

28. FrictionFriction

Frictions are small range, deep manipulations Frictions are small range, deep manipulations
performed on specific anatomical structures performed on specific anatomical structures
with the tips of the fingers or thumbs (no other with the tips of the fingers or thumbs (no other
part of the therapist hand must come in contact part of the therapist hand must come in contact
with the subject body part to be treated)with the subject body part to be treated)

Two types:Two types:
A.A.Circular: performed with finger tipsCircular: performed with finger tips
B.B.Transverse: advocated by James cyriax: known Transverse: advocated by James cyriax: known
as cyriax deep transverse friction massageas cyriax deep transverse friction massage

29. CircularCircular

Finger tips only in a circular Finger tips only in a circular
manner with gradually manner with gradually
increasing depth for three or increasing depth for three or
four circles.four circles.

The pressure is released and The pressure is released and
manipulated againmanipulated again

One hand can reinforce One hand can reinforce
other.other.
TransverseTransverse

To and fro movementTo and fro movement

Pronosupination graspPronosupination grasp

Pincer graspPincer grasp

Pulp of thumbPulp of thumb

30. To and Fro movement:To and Fro movement:
Used for round and flat surfaces.Used for round and flat surfaces. To and Fro movement:To and Fro movement:
Used for round and flat surfaces.Used for round and flat surfaces.
Types of grips for Cyriax deep Types of grips for Cyriax deep
friction massagefriction massage

31. Pronosupination grasp:
For more deeply situated
lesions. Pronosupination grasp:
For more deeply situated
lesions.

32. Pincer Grasp:
Usually for
trigger points. Pincer Grasp:
Usually for
trigger points.

33. Pulp of Thumb:
For flat surfaces,
taut bands,
nodules in flat
surfaces Pulp of Thumb:
For flat surfaces,
taut bands,
nodules in flat
surfaces

34. PercussionPercussion

Percussion manipulations are those the treated part is struck soft Percussion manipulations are those the treated part is struck soft
blows with the hand. blows with the hand.

Whole hand contact/finger tip contact can be used.Whole hand contact/finger tip contact can be used.

Six types:Six types:
A.A.Hacking: skin is struck using the back of the tip of three medial Hacking: skin is struck using the back of the tip of three medial
fingersfingers
B.B.Clapping: whole palmar aspect is used to strike the body part (make Clapping: whole palmar aspect is used to strike the body part (make
sure the hand is cupped slightly)sure the hand is cupped slightly)
C.C.Vibration: involves a movement in which tissues are pressed and Vibration: involves a movement in which tissues are pressed and
released using an up and down motionreleased using an up and down motion
D.D.Beating: dorsal aspect of middle phalanx of loosely clenched fist Beating: dorsal aspect of middle phalanx of loosely clenched fist
(with thumb inside the fist) is used for the strike(with thumb inside the fist) is used for the strike
E.E.Pounding: ulnar aspect of loosely clenched fist is used to strikePounding: ulnar aspect of loosely clenched fist is used to strike
F.F.Tapping: with the tips of finger pads on a smaller are such as face; Tapping: with the tips of finger pads on a smaller are such as face;
index, ring and middle finger may be used together or in a singly index, ring and middle finger may be used together or in a singly
sequence. sequence.

35. 
Hacking Hacking

ClappingClapping

Vibration Vibration 
Beating Beating

36. 
Pounding Pounding

TappingTapping

37. IndicationsIndications
1.1.For tensed musclesFor tensed muscles
2.2.Muscular painMuscular pain
3.3.Tight musclesTight muscles
4.4.Blocked sinusBlocked sinus
5.5.Flaccid musclesFlaccid muscles
6.6.For relaxationFor relaxation
7.7.For scarsFor scars
ContraindicationsContraindications
1.1.Local cancerous Local cancerous
lesionlesion
2.2.Open woundOpen wound
3.3.Skin allergiesSkin allergies
4.4.Deep vein Deep vein
thromobosisthromobosis
5.5.Skin infectionSkin infection
6.6.Operative conditions Operative conditions
with implantswith implants