Myofascial Release/ Therapeutic Massage Techniques

Massage is derived from 2 sources - Arabic verb mass “to touch”

- Greek word massein “to knead”
Massage is the systemic rubbing and manipulation of different part of the body for the
therapeutic benefits.
Massage is a scientific treatment, by certain passive systematic manipulations, upon the skin of the
human body.
Massage is the scientific manipulation of soft tissues of body with hands in order to produce effect
on nervous, muscular & circulatory systems which will help to restore or improve function.
It is a means used to create energy & is a natural method of restoring part either locally or generally
injured, to its normal condition.
Massage demands the skilled use of hands & brain that comes with practice.

What is Massage Therapy?

It is a mechanical modality
Act of rubbing, kneading, or stroking
for the purpose of modifying nutrition, restoring
power of movement or breaking up adhesions
Used to manipulate the body’s tissue
 History of the massage
Massage dates as far back as European cave paintings from 15000BC depicting therapeutic touch.
In the Chinese and indian history massage can be traced back as early as 3000 years ago.
In Ayurveda text, in Dinacharya concept it is mentioned that massage should be done after doing exercise.
“The Cong-Fou of the Tao-Tse”(Chinese text) was probably the foundation both of modern
massage and of the manual Swedish movements.
Early physicians used massage effectively in the treatment of fatigue, illness and injury.
5th century Hippocrates described "anatripis;- rubbing up, as having more favorable effect than
rubbing down on limbs
In late 19th century societies developed with the object of ‘promoting the science of massage,
organizing training & safeguarding the interests of the public and profession’

EFFECT OF
MASSAGE

PHYSIOLOGICAL MECHANICAL PSYCHOLOGICAL

CIRCULATORY CENTRAL NERVOUS MUSCULOSKELETAL

SYSTEM SYSTEM SYSTEM
 MECHANICAL EFFECTS
Removes dead cells.
Allows sweat glands, hair follicles & sebaceous glands to be free of obstruction & function better.
Increases lubrcant effect
Increases warmth
Used in the treatment of scar tissues & adhesions.
Promote & retain mobility of new skin tissues.
Over lungs – frees adherent mucus from bronchial tree.
Encourage hyperaemia (due to histamine release) –increases suppleness of tissues & parasympathetic
activity, relaxes muscle tone, reduces edema and pain.
PHYSIOLOGICAL EFFECTS – CIRCULATORY SYSTEM
Change in skin color – due to increased circulatory flow, blood velocity & blood viscosity.

Effect on BP, HR, skin temperature & conductivity & oxygen consumption.
Increased release of histamine from mast cells & basophills & platelets from blood – initiates triple response –
1. Dilation of minute blood vessels 2. Flush (flare of redness) around area 3. Slight swelling
Massage profoundly effects the general and local circulation, depending upon the mode and area of
application.
General massage increase the rate and force of heart beats.
The vigor of circulatory activities increases.
Massage has chiefly to do with the circulation of fluid in the veins and the lymph channels, since
these are more readily accessible from the surface than the arteries.
 Effect on respiration
Increase cellular respiration:
massage increase the cellular metabolism thus increase o2 consumption and increase production of
co2.
Increase the respiratory activity:
increase the depth of respiration
increase the diaphragmatic action
METABOLIC EFFECTS
Manipulation always affect the cellular activities of the local areas as well as the
distant and internal organs which may be due to mechanical effects or the reflex actions.

Effect on digestion
Improve the appetite
Increase secretion of digestive enzymes
Increase the absorption
Aid in peristalsis

Effect on muscular system

1. Encourage nutrition and development of the muscle.

Massage increases blood circulation increases nutrition that increases the size of muscle firmness and elasticity
2. Excite muscular contraction and increases the force of contraction of muscle.
3. Increase the electro-excitability of the muscles .
Effects of massage on bones and ligaments
It promotes the growth of bones and ligaments and improves blood circulation to the
bones.

Improved muscular and thus bone circulation also influences the blood forming process in red bone
marrow, in both quantity and quality.

Effect on nervous system

Nervous system consist of sensory, motor and autonomic components.
As sedative effect on sensory component.
Pain relief by blocking the pathway of pain conduction.
Activate different sensory receptors present in skin and soft tissues.
Depending on rate of application and degree of pressure massage can elicit facilitating & inhibiting
responses in neuromuscular system.
Exert regulatory influences on the muscle tone.
Influence the functioning of visceral organ by modulating the autonomic nervous system through
peripheral sensory stimulation.
PSYCHOLOGICAL EFFECTS
Positive effects on psychological well being
Increase feeling of relaxation & rest
Decreases anxiety level & stress hormone level
Increased levels of immunoglobin A – improves immune system.
Helps in reducing depression & adjustment disorders.
Improves pain outcomes, mental energy & self rated health.
Improves sleep outcomes
 CONTRAINDICATIONS -ABSOLUTE
Tissue inflammation / malignancy
Circulatory disorders (bleeding tendency)
Abnormal sensations
Skin disorders
Early bruising
Recent, unhealed scars or open wounds
Adjacent to recent fracture site
Acute inflammation / tubercular infection of joint & tissue
h/o or suspected DVT
Burns
Advanced osteoporosis

CONTRAINDICATIONS -RELATIVE
Older people
Those with fragile skin
Early stage of osteoporosis
Children
Adults with learning &/or physical disabilities
People recovering from infections & bone #
 Massage
Manipulation
s

Effleurage
Petrissage Friction Percussive
/Stroking
Manipulation Manipulation Manipulation
Manipulation
s s s
s

-Clapping
Deep Light - Kneading - Circular -Hacking
- Picking -
Up -Vibration
Transverse
- Rolling -Beating
- Wringing -
- Muscle Pounding
shaking
-Tapping
 Effleurage
Preparatory & concluding stroke of massage
Soothing
Brings awareness to part being treated
Used to spread oil, introduces the client to the therapists touch, prepare tissue for deeper work
and is used to palpate temperature, muscle tone and texture.
Effects
◦ vary depending on the depth, rate and rhythm of the technique; effleurage tends to have a more reflexive effect on circulation if less
pressure is used and a more mechanical effect if deeper pressure is used.

◦ Repetitive and sweeping, effleurage is used to increase local venous and lymphatic return, to increase local circulation or to reduce edema.

◦ Slow rhythmic effleurage has a sedative effect, decreasing sympathetic nervous system firing and, in turn, reducing pain and muscle
hypertonicity.

◦ Quick and erratic effleurage is stimulating

Contraindications for Effleurage Techniques

• Never use these techniques distal to an area of inflammation, distal to an injury in the acute and early subacute stage or distal to an area of
infection.

•Technique should not be performed repetitively on the limbs of clients with hypertension, heart disease, varicose veins or edema
caused by a thrombus in a vein.
 Petrissage
 Is any technique which rhythmically compresses and releases the tissue.
 It is often used after the tissue is warmed up because of the increased pressure and focus.
 Petrissage is any technique which rhythmically compresses and releases the tissue, which creates
stretching of the tissue layers.
Types of Petrissage
 Muscle squeezing: The muscle is compressed between
the palm of the fingers or between both palm

 Wringing: Both hands are used. They are placed on

the area and allowed to conform to the tissue. Tension is
created as each hand moves in an opposite direction and
then back
 Picking up: The fingers and thenar eminence or the palms of the hand squeezes the muscle, lifting it up from the underlying
tissue using a vertical pressure

Kneading: fingertips, Usingthumb, palmar surface or ulnar border, perform short, rhythmical unidirectional or circular
movements. Can also be applied by alternating circles
 Effects of Petrissage
All types of petrissage affect local circulation while they are being applied
Different techniques can achieve varying effects depending on the degree of pressure or compression and the amount
of drag applied to the tissue
If increased drag is applied to the tissue, muscle fiber and connective tissue adhesions can be loosened. If only the
skin layer is engaged, on the superficial fascia is addressed.
Muscle hypertonicity is reduced with the repetitive kneading movements of petrissage
Skin rolling is used as an assessment technique used to check for superficial fascial restrictions as well as trigger
points.

Contraindications
Petrissage is not used with most acute conditions and when local massage is contraindicated

With severely atrophied muscles, petrissage is not used because the drag of these techniques could damage tissue

Petrissage should not be used over moderate to severe varicosities.

Percussive Techniques
Vibration
Clapping
Hacking
Shaking
Beating
Pounding
 Vibration
Can be performed with one or both hands

Once the hand is in contact with the tissue, the muscles of the forearm are alternately contracted and then relaxed to
create a rhythmic movement through the hand. When the movement is fast enough vibration is created.

Vibration is more easily performed with relaxed upper arms and shoulders.
Vibrations can be fine or coarse:
◦ Fine vibrations are very short, fast, almost invisible oscillations of the arm and hand
◦ Coarse vibrations are larger and more observable
Vibrations can also be static or running:
◦ Static vibrations keep the hand in continuous contact with tissue without sliding over the client’s skin.
◦ Running vibrations keep the hand in continuous contact with the tissue and then the vibrating hand glides over the client’s
skin. Effects of Vibrations
Vibrations can be used to create a different stimulation of the body because of their unusual feel; this is useful in painful
areas and those which are hyposensitive or need sensory re-education – for example, after a cast has been removed.
Fine vibrations are more soothing than coarse vibrations

Prolonged coarse or fine vibrations, when applied to the thorax, can assist in mechanically loosening the mucus present
in respiratory conditions
Vibrations can be used to decrease muscle tone, making it easier to apply deeper work, if it is applied for more than 30
seconds. It works by confusing the muscle.
Contraindications Local vibrations are not used over uncovered open or contagious skin lesions. Coarse vibrations
may cause a temporary increase in spastic paralysis.
 Tapotment
All types of tapotment are percussive and rhythmic, usually with the two hands alternately applying the pressure. It can be performed
using fingertips, the ulnar border of hands, the full palmar surface of the hand or the fists.
Light Tapotment
The hands are light and springy, with the wrists relaxed; the technique is applied superficially with no force created beneath the skin.
Pincement: The tissue is gently plucked between the thumb and fingertips

Tapping: The tissue is tapped with the fingertips

Heavy Tapotement
The hands are firm, with the wrists relaxed; a deeper force is used that carries below the skin surface.
Hacking: This is performed with the ulnar border of the hand.

Cupping: The hand is held in a cupped position, with the fingers and thumb together; with the wrist pronated, the tissue is struck with
alternating hands
 Beating: the hand is held in a lose fist.Can be performed with extensor surface of fist or with ulnar surface

Effects of Tapotement

The primary purpose of tapotement is to loosen mucus on clients with respiratory conditions.

Heavy tapotment or prolonged light tapotement increases local circulation.

Its generally stimulating and increase sympathetic nervous system firing; it can be used for clients with generalized fatigue
Heavy tapotment may illicit the stretch reflex of the muscles it is applied to, temporarily increasing their tone. Secondary to this, there
is the reciprocal inhibition of the antagonist. For example, tapotement to the quadriceps may temporarily increase their tone but create
a relaxation of the hamstrings, therefore facilitating stretching and lengthening of hamstrings.
Light tapotment is useful to stimulate hypotrophied muscles, though the pressure is a reflection of the health of the muscle. It is also good
for desensitizing areas such as amputation sites or tissue just after a cast is removed
 Cross Fiber Techniques
Incorporated along with strokes to further relax the muscle groups and assist in the elimination of myofascial restrictions.

Cross fiber friction can be used in the subacute and chronic stages of healing to break down adhesions.
Adhesions
Diminish circulation of the blood and lymph and inhibits the ability of the muscle to fully contract and lengthen.

Adhesions may be within muscle fibers and between structures such as ligaments and tendons. Breaking down
adhesions helps to form a smaller more mobile scar.
The technique is applied once the adhesion is located. This is often the most tender spot reported by the client. It is
sometimes palpated as a different texture to the surrounding tissue.
◦ Reinforced fingers or thumbs are used to compress the superficial tissue over the adhesion.
Pressure and Direction
The pressure used is sufficient to penetrate to the depth of the adhesion, while remaining within the client’s pain tolerance.

When the appropriate depth of tolerable pressure is achieved, the therapist moves the fingers back and forth at right
angles to the fibers of the tissue. The width of each movement, or sweep, is sufficient to produce
movement between the superficial tissue and the adhesion, between the structure treated and
the surrounding tissue, or across the width of the structure being treated, such as a ligament or tendon.
Initially the pressure is to the client’s pain tolerance. After one or two minutes of treatment, the analgesic effect occurs and the
client will report that the area is less tender. If the tenderness has not subsided, or if pain has increased, the technique is
discontinued. Most commonly, the area is less tender and the therapist gradually increases the pressure
to the client's new tolerance. The frictions are continued at this deeper level, breaking down more adhesions while
the analgesic effect is present.
Duration
Depending on the client’s pain tolerance, friction may be applied initially with less pressure and for shorter periods of time
over several sessions, gradually increasing the length of time the technique is used. In clinical experience 2 – 4
minutes for a chronic adhesion is reasonable for each application.

After frictions, repetitive effleurage may be used to increase local circulation through the injury site and to decrease
remaining pain perception.
Frequency

◦ The number of sessions varies from 6 – 12 performed over three weeks. Most overuse syndromes respond in
two weeks to two months.
Contraindications
Frictions are not used over peripheral nerves, with acute injury, rheumatoid arthritis, infective arthritis, structures that
are too deep to be reached, client’s use of anti-inflammatories, anticoagulants or high-dose long-term
steroid medication, peripheral vascular disease, fragility of the skin or soft tissue to be treated and client
discomfort with the technique
Stretching

◦ Muscles are stretched during a massage treatment for them to better understand the neuromuscular changes that have occurred
during the session.
◦ Maintaining muscle length through stretching reduces the overall level of stress in the body and helps eliminate many of the
muscular imbalances that can result in pain and injury.
◦ Reeducate muscle memory
PREPARATION FOR MASSAGE
Check before starting massage that –
Reach all the body parts
Stand in walk or lunge standing
Change position without hesitation if needed
SELF PREPARATION
Attention to personal appearance, hygiene & manicure is important.
Wear protective clothing (easy laundry, freedom of movement)
Restrain long hair, jewelry
Well care of hands
Cleanliness (avoid infection) – hand wash before & after treatment
Use warm hands
Maintain ROM of forearm & arm which stretches (abduction/extension of thumb, flexion/extension of wrist,
pronation/supination)
THE ENVIRONMENT
Quiet with discreet colors, well heated, well ventilated

Couch / chair – padded, adjustable, washable covers

Towels (to cover untreated part), pillows, disposable paper sheets
CONTACT MEDIUM
For easy glide – to reduce friction
Powder (talcum powder/ corn starch) Oils (pure lanoline)
Liquid oils (vegetable oils, liquid paraffin, baby oil)
Creams (water based lubricants, soap & water)
ALLERGIC REACTIONS
Some contact medium might cause mild to severe allergy

Check allergic response before use

Eg. Nut & wheat content

PREPARATION OF PATIENT
Undress (part to be treated) – free of jwellery

Upper Limb (neck to fingers)

Lower Limb (groin to toe)

Back (head to buttock)

Neck (head to T12)

Face (hairline to just below clavicle)
Keep patient warm
Position pillows
PALPATION & DEVELOPING SENSORY AWARENESS
Palpation – skill acquired with practice
Hands should be clean, warm, relaxed, firm, comfortable contact.
Thinking hands (mind investigates structures, felt by hands, identify structures & become aware of variations)
Learn with colleagues – very firm (drill dragging), firm & very light (butterfly) pressure to different body
parts;
palpate for specific anatomical features (arteries, veins, tendons, muscles, bony prominences)
Only touch – no tickle Should be done
EXAMINATION OF PART
Look at skin state (dry/ oily/ wet/ hairy) (bruises/ abrasions/ lacerations).
The feel
Check the vitals-BP, HR/PR, OXYGEN SATURATION LEVEL, RR ETC.
Always put hands in very firm contact & never lift hands off by tackling
No one hand component (especially fingers)
Light works tickle, so perform manipulations at maximum depth as tolerated.