Therapeutic massage and myofascial mobilization

Therapeutic massage and myofascial mobilization

اسلاید 1: www.tabaye.ir

اسلاید 2: Therapeutic massage and myofascial mobilizationAila Nica J. Bandong, PTRPInstructorDepartment of Physical TherapyCollege of Allied Medical Professions

اسلاید 3: Learning objectivesAt the end of the lecture, the students should be able to:Discuss therapeutic massage and myofascial mobilization in terms ofphysiologic mechanismbenefits for useindications, contraindications and precautionsDiscuss the basic techniques of therapeutic massage and its variantsEnumerate the different techniques of myofascial mobilization Cite evidence on the effectiveness of therapeutic massage and myofascial mobilization in the given sample cases

اسلاید 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.

اسلاید 5: Therapeutic effects of massage

اسلاید 6: Goals of massage Mobilize interstitial fluid Reduce or modify edema Increase blood flow Decrease muscle soreness or stiffness Alleviate pain Prevent or eliminate adhesions Facilitate relaxation

اسلاید 7: Benefits of massageRelaxationPain reliefReduction of edemaIncrease ROM Metabolically prepare injured or involved muscles for exerciseEncourage confidence of patientEvaluate patient’s soft tissuesPrepare healthy muscles for strenuous sports activityAssist the body in recovering from the aftereffects of strenuous activity

اسلاید 8: indicationsTense muscles Scar tissueEdemaPain

اسلاید 9: contraindicationsMalignancyThrombiAtherosclerotic plaquesInfectionsScars that are not fully healedPatients on anti-coagulantsCalcified soft tissueSkin graftsAtrophic skinChronic subluxationPathologic conditions that could be spread along the skin, through the lymph or the blood. Area where there is bleedingAreas of acute inflammationPhlebitis

اسلاید 10: precautionsDisorders of circulatory system Areas with abnormal sensationOver recent surgery Joint replacements Immunocompromised patientsIn the presence of medications that may alter sensation, muscle tone, standard reflex reactions, cardiovascular function, kidney and liver function and personality

اسلاید 11: limitationsWill not reduce obesityWill not delay loss of muscle strengthWill not hasten recovery of sensation after nerve injury

اسلاید 12: Massage variants

اسلاید 13: effleurageAka stroking massageTherapist’s hands glide across the skin overlying the muscle being treatedSuperficial effleurageDeep effleurage

اسلاید 14: purposesPromote relaxationNote areas of spasm and tightnessGet the therapist’s hands from one problem area to another Accustoms the patient to the touch of the therapistThe only technique that may be employed in instances of extreme soreness Deep effleurage will provide a passive stretch to given muscles or muscle groups

اسلاید 15: variations KnucklingLoose fistSingle/double hand Three-count stroking of the trapezius Horizontal stroking Single/double forearm

اسلاید 16: petrissageAka kneading massageStrokes that attempt to lift the muscle mass and wring or squeeze it gentlySoft 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 compressionApplied vertically in relation to the tissues

اسلاید 17: purposesRemove waste productsAssist venous returnEffective in decreasing hypertonicity Beneficial in mechanically softening the superficial fascia

اسلاید 18: variationsPicking- upPinchingRollingWringingFulling MilkingFist kneadingDigital kneadingAlternating two-hand petrissageTwo-finger petrissage One-hand petrissageAlternate one-hand petrissage

اسلاید 19: FrictionAka deep friction massagePressure of varying intensities is applied with the ball of the thumb or fingersMechanical 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 mostimportant massage techniqueGenerally performed for 30seconds to 10 minutesNo lubricant used

اسلاید 20: PurposesMassage into deep joint spaces or around bony prominencesBreakdown connective tissue and scar adhesions except deep fibrositis in muscle bellyFor pain reduction through mechanism of counterirritation and hyperstimulation analgesia

اسلاید 21: variationsCross-fiber techniqueStorm’s techniqueCyriax’s friction massage

اسلاید 22: tapotementAka percussion massageThe skin and muscle are impacted with repetitive compressive blows by the hands

اسلاید 23: PurposesUsed when stimulation is desiredUsually performed in athletesCan be done to prepare patient for stretchingUsed to loosen mucus in the lungs

اسلاید 24: variationsHackingCuppingFist beatingBeating over palmSlappingFinger tapping

اسلاید 25: vibrationA fine tremulous movement made by the hand or fingers placed firmly against a part Can be used better with electrical vibratorFollows the path of the nerve in treatment of peripheral neuritis

اسلاید 26: purposesUsed for a soothing effect especially in peripheral neuritis Can be used to relax antagonist muscle through reciprocal inhibition Break up monotony of massageCan be used to loosen consolidations in the lungs

اسلاید 27: CompressionVertical pressing downward that penetrate the subcutaneous layerCan be done using the thumb, heel of the hand, palm, fist, knuckles, forearm, elbowTherapist stays perpendicular with actual compression (~45 to 90 degrees to the body)

اسلاید 28: purposesCan be used to replace effleurage if gliding strokes can not be performedUsed to tone the musclesStimulates the muscle spindle

اسلاید 29: shakingRelaxes muscle groups or an entire limbWarms and prepares the body for deeper bodyworkIndicated for extremely tight musclesRockingSoothing and rhythmic method used to calm an individualUp-and-down and side-to-die movement of the body

اسلاید 30: Massage forces are applied using the fingers on acupuncture pointsLocalized finger pressure coupled by circular movementsPressure is increased until pressure becomes heavy then held constant acupressure

اسلاید 31: 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 point produces change in the structure mapped to that point.Reflexology and auriculotherapy

اسلاید 32: Shi (finger) and atsu (pressureJapanese form of acupuncturePressure is applied at specific points (meridians)Was first administered by blind cliniciansshiatsu

اسلاید 33: MilieuTreatment variablesFriction-reducing mediumRhythmRatePressureDirectionArea to be treatedDurationFrequencyDuration of the programMassage variables

اسلاید 34: M y o f as c I alMOBILIZATIOn

اسلاید 35: Myofascial Release TheoryFascia: three-dimensional web of connective tissue running continuously through the body and superficial to deep without any interruptionThree layers:SuperficialDeepDural

اسلاید 36: Myofascial Release TheoryFunctions of Fascia:Holds tissues togetherSeparates structures to allow mobilityProtection, nutrition, elimination, and metabolismComposition:CollagenElastinGround substance

اسلاید 37: Myofascial Release TheoryFascial RestrictionsCause excessive pressures on pain sensitive areas as well as excessive tensile force on the neuromusculoskeletal sturcturesSets up the environment for poor cellular efficiency, necrosis, disease, pain , and dysfunction throughout the bodyDysfunction along the deepest/dural fascia can have neurologic effectsA restriction in one area may cause restrictions in other areas of the body

اسلاید 38: Myofascial MobilizationAlso known as trigger point therapy, myofascial release Since fascia has colloidal properties it can be manipulated and stretched by sustained by pressureEffect is loosening of fascia  release restrictions or barriers within the fascial layers  relieve symptoms and promote normal quality and quantity of motion

اسلاید 39: Myofascial releaseA whole-body “hands-on” approach to evaluation and treatment of the human structureEvaluation of fascial systemInterventionRe-evaluationIncorporated in a comprehensive program that includes modalities, therapeutic exercise, muscle energy techniques, mobilization and manipulation

اسلاید 40: PainMovement restrictionsSpasmNeurologic dysfunctionSports injuriesChronic fatigue syndromeFibromyalgiaPediatricsScoliosisMenstrual, pelvic, temporomandibular painHeadacheindications

اسلاید 41: MalignancyFebrile stateAcute circulatory conditionAneurysmAcute rheumatoid arthritisSuturesHealing fractureOsteoporosis or advanced degenerative changesSystemic or localized infectionOpen woundsAnticoagulant therapyAdvanced diabetesContraindications

اسلاید 42: Basic techniques Cross-hand techniquesArm or leg pull (unilateral or bilateral)Cranial base releaseSkin rollingScar releaseJ-stroke

اسلاید 43: Thank you for listening!!!Any questions?

اسلاید 44: referencesBrault, J. S., Kappler, R. E., Grogg, B. E. (2007). Manipulaiton, traction, and massage. In Braddom, R. L. (Ed) Physical medicine & rehabilitation. Philadelphia: Elsevier Inc.Cantu, R. I., Grodin, A. J. (1992). Myofascial manipulation: Theory and clinical application. Maryland: Aspen Publishers, Inc.de las Peñas, C.F., Campo, M.S., Carnero J.F. & Page, J.C.M. (2005). Manual therapies in myofascial trigger point treatment: a systematic review. Journal of Bodywork and Movement Therapies. Retrieved July 28, 2008 from http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B6WHF-4D97YT8-1&_user=10&_rdoc=1&_fmt=&_orig=search&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=1a86d354ca36e2b5c7e9e62aed07dc37.Fritz, S. (2000). Fundamentals of therapeutic massage (2nd ed). USA: Mosby-yearbook, Inc.Gomez, M. Z. A. (2008). Lecture notes on massage and myofascial mobilization. UP- Manila College of Allied Medical Professions.Rechtien, J. J., Andary, M., Holmes, T., and Wieting, J. M. (1998). Manipulation, massage, and traction. In De Lisa, J., and Gans, B. Rehabilitation medicine: Principles and practice (Eds). Philadelphia: Lippincott-Raven Publishers.Rickards, L.D. (2007). The effectiveness of non-invasive treatments for active myofascial trigger point pain: A systematic review of the literature. International Journal of Osteopathic Medicine. Retrieved July 28, 2008 http://www.sciencedirect.com/science?_ob=ArticleURL&_udi=B7RM5-4MK0N7B1&_coverDate=12%2F31%2F2006&_alid=522228570&_rdoc=1&_fmt=&_orig=search&_qd=1&_cdi=25741&_sort=d&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=4f44892772cc6bbc024dc953f16bdffb.Tappan, F. (1988). Healing massage techniques: Holistic, classic, and emerging methods (2nd ed). Connecticut: Appleton & Lange.