صفحه 1:
صفحه 2:
THERAPEUTIC
MASSAGE
AND
MYOFASCIAL
MOBILIZATION
Aila Nica J. Bandong, PTRP
صفحه 3:
LEARNING OBJECTIVES
At the end of the lecture, the students should
be able to:
* Discuss therapeutic massage and
myofascial mobilization in terms of
= physiologic mechanism
= benefits for use
" indications, contraindications and precautions
Discuss the basic techniques of therapeutic
massage and its variants
* Enumerate the different techniques of
myofascial mobilization
* Cite evidence on the effectiveness of
therapeutic massage and myofascial
mobilization in the given sample cases
صفحه 4:
WHAT IS MASSAGE?
Massage is the therapeutic
manipulation of the soft tissues
of the body with a goal of
normalization of those tissues.
Also defined as hand motions
practiced on the surface of a
living body with a therapeutic
goal.
صفحه 5:
THERAPEUTIC EFFECTS OF
MASSAGE
mechanical _ —
Assist in venous
and lymphatic flow
tissue
ت0۵ م
لت ۱۳
صفحه 6:
GOALS OF MASSAGE
* Mobilize interstitial fluid
* Reduce or modify edema
* Increase blood flow
* Decrease muscle soreness or
stiffness
۰ Alleviate pain
* Prevent or eliminate adhesions
* Facilitate relaxation
صفحه 7:
ات *
* . ۳۵۱۳ ۵۱۲
* Reduction of edema
* Increase ROM
* Metabolically prepare
muscles for exercise
* Encourage confidence of patient
* Evaluate patient’s soft tissues
* Prepare healthy muscles for strenuous
sports activity
* Assist the body in recovering from the
aftereffects of strenuous activity
صفحه 8:
-ATIONS
Tense muscles
Scar tissue
Edema
Pain
(INDI
صفحه 9:
CONTRAINDICATIONS
* Malignancy * Atrophic skin
* Thrombi * Chronic subluxation
* Atherosclerotic * Pathologic
plaques conditions that could
۱ be spread along the
Infections skin, through the
* Scars that are not lymph or the blood.
fully healed ۰ Area where there is
* Patients on anti- bleeding
coagulants * Areas of acute
* Calcified soft tissue inflammation
* Skin grafts * Phlebitis
صفحه 10:
PRECAUTIONS
* Disorders of circulatory system
٠ Areas with abnormal sensation
* Over recent surgery
* Joint replacements
* Immunocompromised patients
* In the presence of medications
that may alter sensation, muscle
tone, standard reflex reactions,
cardiovascular function, kidney
and liver function and personality
صفحه 11:
LIMITATIONS
* Will not reduce obesity
° Will not delay loss of muscle
strength
* Will not hasten recovery of
sensation after nerve injury
صفحه 12:
Effleurage or
__ Stroking massage _
Petrissage or
_Kneadingg massage
__ Tapotement or |
Percussion massage
| Friction or Deep
friction massage
| Vibration
|
کی لتنا
۱
MASSAGE
VARIANTS
Acupressure
a 275955
الع سدم Zell تتا
Shiatsu |
صفحه 13:
EFFLEURAGE
* Aka stroking massage
* Therapist’s hands glide across the skin
overlying the muscle being treated
™ Superficial effleurage
™ Deep effleurage
أحسن يد سا وجييد يد
r 1 ۳ 3 ١ ۲
صفحه 14:
PURPOSES
* Promote relaxation
* Note areas of spasm and tightness
* Get the therapist’s hands from one
problem area to another Accustoms the
patient to the touch of the therapist
* The only technique that may be
employed in instances of extreme
soreness
* Deep effleurage will provide a passive
stretch to given muscles or muscle
groups
صفحه 15:
VARIATIONS
* Knuckling
* Loose fist
* Single/double hand
* Three-count stroking of the
trapezius
* Horizontal stroking
* Single/double forearm
صفحه 16:
PETRISSAGE
* Aka kneading massage
* Strokes that attempt to lift the muscle
mass and wring or squeeze it gently
* Soft tissue is compressed between the
hand or fingers of the therapist and
gently squeezed as the hands move in
a circular motion perpendicular to the
direction of compression
* Applied vertically in relation to the
tissues
صفحه 17:
PURPOSES
* Remove waste products
° Assist venous return
* Effective in decreasing
hypertonicity
* Beneficial in mechanically
softening the superficial fascia
صفحه 18:
Picking- up
Pinching
Rolling
Wringing
Fulling
Milking
Fist kneading
Digital kneading
Alternating two-hand petrissage
Two-finger petrissage
One-hand petrissage
Alternate one-hand petris:
صفحه 19:
riON
° Aka deep friction massage
* Pressure of varying intensities is applied with
the ball of the thumb or fingers
Mechanical effect is the application of shear
stresses to the underlying tissue specifically
at the interfaces (dermis-fascia, fascia-
muscle, muscle-bone, scar tissue-bone)
Considered as the most
important massage technique
Generally performed for 30
seconds to 10 minutes
No lubricant used
صفحه 20:
PURPOSES
* Massage into deep joint spaces
or around bony prominences
* Breakdown connective tissue
and scar adhesions except deep
fibrositis in muscle belly
* For pain reduction through
mechanism of counterirritation
and hyperstimulation analgesia
صفحه 21:
VARIATIONS
* Cross-fiber technique
* Storm's technique
* Cyriax’s friction massage
صفحه 22:
TAPOTEMENT
* Aka percussion massage
* The skin and muscle are
impacted with repetitive
compressive blows by the hands
صفحه 23:
PURPOSES
* Used when stimulation is desired
* Usually performed in athletes
* Can be done to prepare patient
for stretching
* Used to loosen mucus in the
lungs
صفحه 24:
VARIATIONS
* Hacking 1 3
* ۵9 ft
* Fist beating
* Beating over palm
* Slapping :
* ۲۱۱96۲ 0019 fe
|
صفحه 25:
VIBRATION
* A fine tremulous movement
made by the hand or fingers
placed firmly against a part
* Can be used better with
electrical vibrator
* Follows the path of the nerve in
treatment of peripheral neuritis
صفحه 26:
PURPOSES
* Used for a soothing effect
especially in peripheral neuritis
* Can be used to relax antagonist
muscle through reciprocal
inhibition
* Break up monotony of massage
* Can be used to loosen
consolidations in the lungs
صفحه 27:
COMPRESSION
* Vertical pressing downward that
penetrate the subcutaneous
layer
* Can be done using the thumb,
heel of the hand, palm, fist,
knuckles, forearm, elbow
* Therapist stays perpendicular
with actual compression (~45 to
90 degrees to the body)
صفحه 28:
PURPOSES
* Can be used to replace
effleurage if gliding strokes can
not be performed
* Used to tone the muscles
=Stimulates the muscle spindle
صفحه 29:
SHAKING
* Relaxes muscle groups or an entire
limb
* Warms and prepares the body for
deeper bodywork
* Indicated for extremely tight muscles
ROCKING
* Soothing and rhythmic method
used to calm an individual
* Up-and-down and side-to-die
movement of the body
صفحه 30:
ACUPRESSURE
* Massage forces are applied
using the fingers on eee
acupuncture points
* Localized finger pressure
coupled by circular
movements
* Pressure is increased until
pressure becomes heavy
then held constant
صفحه 31:
JLOTHE!
* All parts of the body are believed to be
mapped to different point on the foot
(reflexology) or the ear
(auriculotherapy) and massage of a
صفحه 32:
* Shi (finger) and atsu
(pressure
* Japanese form of
acupuncture
* Pressure is applied
at specific points
(meridians)
* Was first
administered by
blind clinicians
صفحه 33:
* Milieu
* Treatment variables
Friction-reducing medium
=|
mon (eh Ra
Pressure ۳ 3 tcl
Direction | Melina! Ta 1
Area to be treated
Duration
Frequency
Duration of the program
صفحه 34:
صفحه 35:
MYOFASCIAL RELEASE THEORY
* Fascia: three-dimensional web of
connective tissue running
continuously through the body
and superficial to deep without
any interruption
* Three layers:
™Superficial
=Deep
™Dural
صفحه 36:
MYOFASCIAL RELEASE THEORY
* Functions of Fascia:
™Holds tissues together
™Separates structures to allow
mobility
™Protection, nutrition, elimination,
and metabolism
* Composition:
=Collagen
=Elastin
™Ground substance
صفحه 37:
MYOFASCIAL RELEASE THEORY
* Fascial Restrictions
™ Cause excessive pressures on pain sensitive
areas as well as excessive tensile force on
the neuromusculoskeletal sturctures
™Sets up the environment for poor cellular
efficiency, necrosis, disease, pain , and
dysfunction throughout the body
™ Dysfunction along the deepest/dural fascia
can have neurologic effects
"A restriction in one area may cause
restrictions in other areas of the body
صفحه 38:
MYOFASCIAL MOBILIZATION
* Also known as trigger point
therapy, myofascial release
* Since fascia has colloidal
properties it can be manipulated
and stretched by sustained by
pressure
۰ Effect is loosening of fascia >
release restrictions or barriers
within the fascial layers > relieve
symptoms and promote normal
quality and quantity of motion
صفحه 39:
MYOFASCIAL RELEASE
٠ A whole-body “hands-on” approach
to evaluation and treatment of the
human structure
"Evaluation of fascial system
=|ntervention
™Re-evaluation
* Incorporated in a comprehensive
program that includes modalities,
therapeutic exercise, muscle
energy techniques, mobilization
and manipulation
صفحه 40:
INDICATIONS
* Pain
* Movement restrictions
* 3510
* Neurologic dysfunction
* Sports injuries
* Chronic fatigue syndrome
* Fibromyalgia
* Pediatrics
* Scoliosis
* Menstrual, pelvic,
temporomandibular pain
* Headache
صفحه 41:
CONTRAINDICATIONS
° Malignancy
* Febrile state
* Acute circulatory condition
° Aneurysm
* Acute rheumatoid arthritis
* Sutures
۰ Healing fracture
* Osteoporosis or advanced
degenerative changes
* Systemic or localized infection
* Open wounds
* Anticoagulant therapy
* Advanced diabetes
صفحه 42:
BASIC TECHNIQUES
* — Cross-hand techniques
* — Arm or leg pull (unilateral or bilateral)
* Cranial base release
* — Skin rolling
* Scar release
۰ |۵۵
صفحه 43:
THANK YOU
FOR
LISTENING!!!
Any questions?
صفحه 44:
REFERENCES
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اک
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