Course description

This course is designed to focus:

◦ on the basic concepts and characteristics of
massage
◦ Types and classification of massage
◦ Techniques of massage
◦ Application of masaage
◦ massage before and after injuries
◦ Massage during sport activities (sport massage )
◦ Exercise therapy

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Course objectives
At the end of this students will be able to :
◦ Understand the history of massage
◦ Familiarize with the basic concepts of
massage and therapeutic exercise
◦ Apply their knowledge of massage and TE in
teaching and coaching process
◦ Demonstrate the basic techniques of massage
◦ Prescribe exercise for rehabilitation

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Course content
Chapter One
◦ Introduction to Massage
Chapter Two
◦ The Effects and Benefits of Massage
Chapter Three
◦ Preparation for Massage

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Chapter Four
◦ Classification of Common Massage and
Their Application
 Classification of Massage
 Basic Techniques of Massage
Chapter Five
◦ Sports Massage
Chapter Six
◦ Exercise Therapy

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Mode of delivery
◦ Lecture
◦ Gaped lecture
◦ Discussion
◦ Demonstration
◦ practice

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Mode of assessment

Quizzes
Assignments
Practicalworks
Final exam

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Reference
Margaret Hollis(1998):Massage for
therapist.2nd edition
Pastricia J.Benjamin(2005) understanding
sport massage
Ramella Mills (2004) sports massage

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CHAPTER ONE

Introduction to Massage

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Definition
Massage is the systematic manipulation
of the body’s soft tissues, primarily the
muscles, to benefit the nervous, muscular
and circulatory systems.

Usually this manipulation is performed with the

hands, although some forms of massage also use the
forearms, elbows, knees and even the feet.

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The word massage comes from the Greek
‘masso’ meaning to knead.
Massage may be the oldest method of
treating human ills.
Massage probably originated from our
natural impulse to rub an ache or a bump to
relive pain, over time this rubbing has been
formalized in to a number of different
movements applied to specific parts of the
body.
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Mostforms of massage involve
combinations of these movements
stroke,
kneading,
wringing,
pulling,
vibrating,
percussion (tapping or striking) and
pressing.

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Massage therapists use long, smooth
strokes, kneading and other movements
focused on superficial layers of muscle
using massage oil or lotion.

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Historical Development of Massage
Massage therapy dates back thousands of
years. References to massage appear in
writings from
◦ ancient China,
 Japan,
 India,
 Arabic nations,
 Egypt,
 Greece, and
 Rome.

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In ancient Chinese (2998 B.C) a book
entitled “Kung-Fu” (Human art) states,
not only the benefit of massage but also
shows the content and technology of
massage.
In the 4th century in China, the first state
medical institute was opened and the
students were thought massage course as
compulsory.

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The German scientist George Ebers at the
end of 19th century has been studied about
the traditional medicinal plants in Africa.
In his study he explained that before 12 th
century B.C. in Egypt, Libya, Nubian
(now Sudan) and other African countries
massage was known with in the society as
a means of therapeutic procedure.

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In ancient Greek massage was practiced
before and after different physical
exercise and sport competitions.
Heppocrates (460-377 B.C), known as the
father of medicine, defines medicine as
"the art of rubbing") .
He described the benefits of using oils
and massage on joints.

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The ancient Roman doctors have been
adopted methods of the Chinese and
Egyptian massage not only as a means of
therapeutic process bus also they used
for the improvement of physical
performance purposes.
In the ancient Roman massage was the
part of daily life.

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The 14th-15th century in Europe, just after the publication of
a book on human physiology, the interest in techniques of
massage became strong through the society.
In 1780 by known French doctor Klemen Joseph Tisso on
his book called “Medical and Surgical Gymnastic”
explained the systems and application of massage and
gymnastical exercises after clinical surgery treatments.
At the beginning of 19th century method of health and
therapeutic massage with gymnastical exercises was
introduced by Swedish professional Per Hinrik Ling (1776-
1839). In 1913 Stockholm Institute of Massage and
Therapeutic Gymnastic was founded.

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At the end of 19th century in Russia, a
center were founded to prepare
Specialists in therapeutic massage.
In 20th century massage became
developed through-out the world in the
form of health, therapeutic, cosmetic,
recreation, sport etc.
Today the massage is established on the
basis of its movement or strokes.
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 Schools of Massage

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 Schools of Massage
Massage has become an umbrella term for many
methods of body manipulation; most of these can
be grouped into two basic schools.
The Western School of Massage
◦ Swedish massage
◦ Russian massage
The Eastern School of Massage
◦ Thia massage
◦ Shiatsu
◦ Acupuncture (acupressure)
◦ Reflexology
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Western School of Massage
(Swedish, Russian and French) the so-called
structure-based system,
It arises from the European tradition that
focuses on the body’s musculoskeletal
system.
The most widely used in Western method is
Swedish massage, originally designed to
duplicate the muscle movements of Swedish
gymnastics through body manipulation.

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Swedish massage
Itis a vigorous systems of treatment designed to
energize the body by stimulating circulation.
Five basic massage strokes are used to
manipulate the soft tissues of the body.
◦ kneading,
◦ rolling,
◦ vibration,
◦ percussive and
◦ tapping movement
The masseur uses a combination of, these movements

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 Swedish massage
The masseur applies oil, to reduce friction on
the skin.
The client is covered by a sheet, with only
the area being worked on exposed.
The major benefit of Swedish massage
include:
 generalized relaxation,
dissolution of scar tissue adhesions, and
improved circulation(which may speed healing
and reduce swelling from injury)
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Russian massage
The technique alters the basic strokes of
classical massage, so each stroke provides
the client with the least invasive and most
comfortable treatment.
Each stroke in Russian massage has a
known physiological effect on a healthy
or dysfunctional body

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Eastern School of Massages
Are “energy-based” systems derived
from the theory that a vital force
circulates throughout the body. When this
force is blocked by tension or injury,
illness or pain results.
The aim of Eastern techniques is to
unblock areas where this force has
became trapped, thus restoring the flow of
energy.

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The most common energy based types of
massage techniques are :
Shiatsu
Acupressure
Reflexology

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Shiatsu
Itis the most known massage technique of eastern
school
It uses pressure on various vital points called
Tsubos to free blocked energy.
Shiatsu developed in Japan, is a finger-pressure
technique utilizing traditional acupuncture points.
Similar to acupressure, shiatsu concentrates on
unblocking the flow of life energy and restoring
balance in the meridians and organs in order to
promote self-healing.

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 shiatsu
With the client reclining, the particular applies
pressure with the finger, thump, palm, elbow,
or knee to specific zones on the skin located
along the energy meridians.
The treatment brings about a sense of
relaxation while stimulating blood and
lymphatic flow.
The benefit of this treatment may include pain
relief and a strengthening of the body’s
resistance to disease and disorder.
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Acupressure and reflexology involve
applying pressure at vital points.
The traditional Chinese medicine includes
various components of massage for
example acupuncture.

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Conclusion
Massage therapists have realized that the
Western and Eastern techniques are not
mutually exclusive, but in fact can
complement each other.

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 Chapter two
The Effects and Benefits of Massage

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Massage does more than make feel good.
Any form of Soft Tissue Manipulation
(STM )techniques applied ,causes several
physiological changes on the different
systems of the body.
In general, massage has two main effects.
◦ These are Mechanical and
◦ Sensory (reflexive response).

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Mechanical Effect of Massage:
The rhythmic movements of massage induce
relaxation, which prepares the muscles for several
other direct physiological changes, known as
mechanical effect.
Mechanically, massage can displace the contents
of the area being treated, thus stretching and
mobilizing the tissues and removing fluids
(blood, lymph, waist).
The examples :
◦ increase blood circulation, reducing swelling and
breaking up of scar tissues.
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Sensory Effects of Massage
These effects are reflex (local) and psycho-somatic
(conscious perception),
◦ the nerve impulses, triggered by rhythmic massage
motions, are relayed to the central nervous system (the
brain and spinal cord), where they are translated in to
message of relaxation that are sent back to the muscle.
Massage response can be primarily mechanical or
reflexive in a nature but both responses are closely
related and often occur simultaneously.
Reflex responses to Soft Tissue Manipulation
frequently occur due to mechanical stimulation of
nerve receptors.
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Effect of Massage on the Body
Massage has effects on different organs
and bodily systems.
It has effects on Circulatory ,
lympahatic, Muscular ,Nervous
,Skeletal System and on the Skin.

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Effects of Massage on Circulatory System.
It enlarges blood vessels, thereby increasing
circulation.
It speeds up the passage of deoxygenated blood
back to the heart, and oxygenated blood away from
the heart to tissues and vital organs
It facilitates the removal of byproduct(lactic acid )
from muscular activity that causes fatigue.
It increase blood flow (circulation ) …..it reduces
the pulse rate and promotes relaxed breathing,.
It must be noted that all strokes should be
performed towards the heart.
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Effects of Massage on Lymphatic system
Massage also encourages the flow of
lymph, a colorless fluid that transports
proteins and other substances from the
muscles and bones to the blood.
The increased lymph flow helps prevent
infections and fluid accumulation that can
lead to swollen tissues and joints.

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Effects of Massage on Muscular System.
 It help muscles to stretches and relax
 It promotes flexibility and increase the range of motion.
 Reduce muscle spasms/cramp, and stiffness
 It helps to restore weak, tight or atrophied muscles.
 It helps the body by removing lactic acid and other waist
products, from the muscles.
 Injury or overuse can cause the individual fibers within
a muscle to stick together, limiting their contraction.
When applied the massage (cross fiber) across the grain
of the muscle fibers, can separate matted fibers. Used
regularly, cross-fiber massage helps to prevent injury
and keep muscles functioning optimally.
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Effects of massage on the Skin.
It is improve skin tone which stimulate the
nerve receptors in the skin.
It improves/assists execration processes
As a result of massage flow of blood and
lymph, increase the superficial blood vessels
(arterioles and capillaries) get dilated as they
are massaged and increase the local blood
circulation.
Promote tissue regeneration, reducing scar
tissue and stretch marks.
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Effects of Massage on Skeletal System.
Massaging the area around the fractured
bones significantly increased the retention
of nitrogen, sulfur and phosphorus.
There is also some evidence that because
of its ability to increase blood flow,
massage may aid in bone and tissue
repair, and many physical therapist
includes massage in their treatment of
fractures.

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Effects of massage on Nervous System.
It stimulates the sensory receptors in the skin.
The information about the type of stimuli is
sent to the brain, and makes the brain aware
of stimuli.
it promoting relaxation’
It could reduces stress by temporarily
lowering the heart and pulse rate,
It can contribute to slower more relaxed
respiration.

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Benefits of Massage on the body:
Increase joint flexibility-
Promotes better pulmonary function and
increased peak air flow.
reduces pain, itching and anxiety
Relax and soften injured, tired and
overused muscles
lower systole and diastolic blood
pressure.

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Alleviate lower back pain and improve
range of motion.
Assists shorter and easier labor in delivery
Enhance immunity by stimulating lymph
flow –the body’s natural defense system
Lessen depression and anxiety
Improves concentration
Enhance quality sleep.

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Helps sportsmen of any level prepare for,
and recover from strenuous workouts.
Reduce post surgery adhesions and
swelling
Release endorphins that work as the
body’s natural painkiller
Relive migraine pain

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Contraindications of massage
Abnormally high body temperature (fever
Edema or Hemorrhage due to any heart, lung, liver,
or kidney dysfunction.
severe health condition (e.g., severe insulin-
dependent diabetes or high blood pressure),
The response to touch (reflex effect on nervous
system) could make the disease worse.
In cardiovascular diseases, massage could dislodge
a thrombus (blood clot), resulting in an embolus
(floating blood clot), tumors, thrombosis or varicose
veins and causing heart attack or stroke.
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frostbite
localcontagious or irritable skin
conditions
open sores or wounds
recent surgery
recent burn
varicosities
tumor

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Circulatory massage is contraindicated for
any client on an anticoagulant.
◦ Medications that slow the clotting process would
be compromised by massage that increases blood
flow.
Pregnant women should avoid abdominal
massage
Avoid massage during alcohol drinking
(minimum before 6 hrs)
 Avoid massage During eating (before 2 hrs)

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Acute flare-up of inflammatory conditions such as
rheumatoid arthritis 
Deep vein thrombosis
aneurism
frostbite
local contagious or irritable skin conditions
open sores or wounds
recent surgery
recent burn
varicosities
tumor

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Vulnerable Massage Areas of the body
Vulnerable massage areas of the body
indicates areas of the body which may put
the person/the body in danger as it
massaged.
Some vulnerable areas of the body are
exposed during a massage.
Highly trained massage therapists can
actually work in these areas

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Front of the neck/throat:
◦ this area contains the carotid artery and major
nerves.
Side of the neck:
◦ It’s not quite as sensitive as the front of the
neck, but you should still treat it cautiously.
The ear notch:
◦ behind your jawbone and beneath your ear
contains a sensitive facial nerve

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The axilla:
◦ The axilla is the armpit
◦ This sensitive area is full of nerves, arteries, and
lymph glands.
The upper inner arm:
◦ Just down from the armpit, along the inside of the
upper arm, is a sensitive, nerve-filled area along the
length of the arm bone.
The ulnar notch of the elbow:
◦ Otherwise known as the funny bone, this spot
contains the ulnar nerve.
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The eyeball:
The abdomen:
◦ This area is filled with many important organs
(the liver, gallbladder, and spleen.)
The lower back:
◦ Don’t press too hard ;the kidneys is found just
to both sides of the spine and below the ribs.

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The femoral triangle:
◦ This area is often referred to as the groin.
◦ It’s the inner part of the line in front where
your leg meets your body. Pressing too hard
here can actually cut off circulation to the leg.
Popliteal area:
◦ Popularly known as the back of the knee, this
spot is sensitive to pressure.

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Chapter Three
Preparation for Massage

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Important Guidelines
Masseurs can tailor a massage to suit any needs; even a single
techniques can be stimulating or soothing (calming)
depending on how you do it. i.e. a firm, brisk massage is
invigorating (stimulating) while slow, steady strokes can send
someone to sleep.
Important thing in massage is experimenting. Each time in
massage, find out your clients needs and his reaction and give
a massage that suits him.i.e. Adopt those manipulations that
produce a pleasant sensations and reject those not well come.
Whether you follow a sequence rigorously or improvise your
own techniques; the following types will help make your
massage a wonderful experience.
.

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The client have remove glasses and all jewelry
Keep your nails trimmed, since long nails can cause pain.
If it held a full massage begin on client’s back;complete all work
on the back of the body before asking the client to turn over.
On both the back and the front of the body massage should
proceed from the top of the body down the trunk, finishing with
limbs.Work one area of the body completely, then move on to an
adjacent area
Start the massage treatment with very light movements, suitable
for the first approach with a new human approach then to very
strong. It should be lighter over bony areas & firmer (stronger)
over the area of large muscles. Do not be afraid to apply deep
pressure, that a firm touch feels good

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 Important Guidelines
Exit from a session in the same way of the start. End the massage
with movements that become gradually slower, lighter and gentler.
Avoid sudden stop which could interrupt the state of relaxation.
Carry out the massage with calm, predictable rhythm. A rhythmic
massage will send waves of relaxation throughout the body.
Ask the recipient to tell you if things you do is unpleasant or painful.
Any soreness your client feels during or immediately often the
massage is due to the release of metabolic by-products like uric acid
and lactic acid in to the blood stream; the soreness should disappear
within an hour or so
Some people even fall asleep during a massage. If this happens,
proceed as usual, and let him or her rest quietly for several minutes
often you have completed the massage.

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Mould your hands to the counters of the body, and imagine you are
sculpting the body in to its perfect shape.
Keep one hand in contact with the body throughout the massage of any
area ideally, your hole body massage should be feel like one
continuous, following stroke.
If the use of force is necessary during your massage, simply use the
weight of your body to apply pressure.
Do not talk too much, and concentrate on the massage. The massage
will become effective if both of you focus attention on the various
sensations.
Take care of your joints (of finger, thumbs, and wrist) by not having
them hyper extended when applying techniques that require pressure to
avoid chronic injuries. Because repetitive pressure through hyper
extended joints can cause inflammation of joints as a result of damage
to the tendons of the wrist flexors.

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 Important Guidelines
Do not talk too much, and concentrate on the massage. The massage
will become effective if both of you focus attention on the various
sensations.
Take care of your joints (of finger, thumbs, and wrist) by not having
them hyper extended when applying techniques that require pressure
to avoid chronic injuries. Because repetitive pressure through hyper
extended joints can cause inflammation of joints as a result of damage
to the tendons of the wrist flexors.
Do not worry if your first movements seem clumsy. All touch feels
good, and with practice your massage will become flowing and
confident.
To give a good massage you need to be totally relaxed, so don’t try
too hard. If in doubt about what to do next, just stroke. As long as
your movements are rhythmic, the massage will feel interesting and
relaxing.

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On the extremities, the direction is centripetallyor toward the heart.
(Blood flows to the heart through veins, which have onewayvalves.
Pressure on these valves must be exerted in one direction only;
hence,application of any massage stroke pushing blood through these
valves must be towardthe heart.)
For example, effleuraging up the leg is applying effleurage from the foot,
overthe lower leg, and over the upper leg to the upper thigh (toward the
heart).
Before giving a massage to someone for the first time it is most important
that youcheck their medical history and discuss any present health
problems with them before commencing. Immediately before any
physical contact is made, you should take a moment to clear your mind of
all extraneous thoughts so as to be totally centered on your partner's
needs and to be able to attend to them in a calm and empathetic state. A
few slow, deep breaths with controlled exhalation will help this relaxing
process.

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General Requirements for Massage

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Surrounding:
the surrounding should be
◦ airy,
◦ hygienic,
◦ spacious welcoming and
◦ give an impression of order and efficiency.
the room should be warm, To around 230c.
◦ Cool or chilly air may not only feel unpleasant,
but can also cause the muscles to contact thereby
reducing the effectiveness of the massage.
◦ The windows should be closed during massage.
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Have plenty of towels, cotton bed sheet,
or a couple blankets.
Use soft, suffused or dim light.
 Avoid direct rays on the face;
avoid bring overhead or fluorescent lights

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Music
many participants fever a musical
background while others prefers silence.
However, the choice depends on you and
the recipient preference. Mostly the
customer choice should be given priority.

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Massage surface
use massage couch, the floor or the table,
high about the top of the masseurs’ thigh.
While using the floor, pad the floor with a
piece of foam rubber or air, a couple of
blankets, and kneel (use soft materials to
avoid knee pain/injuries.)
N.B. - do not use bed because the recipient
will sink in to it as pressure is applied and
also it is bad for the masseur’s lower back
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Massage Table

A table is preferable, it allowed the masseur to move around easily and

does not strain your knees and back.
measure about 60-80 cm height, 65-68cm width and 200-210 cm length.
(wood or metal)
Adjusted table to the height of the top of things, place a one inch thick
foam pad on top, before giving massage, cover the pad with a clean sheet
to protect it from oil.

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Towels and Cushions:
Towel
Used to cover parts of the body that are not
being massage.
Initially the whole the recipient should be
covered but then uncover each area as its
massage.
The towels should be held down along one
side as the recipient rolls over. So that, he
remains covered throughout the massages
procedure.
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Cushions or Pillow:
◦ in the supine position (lying face up), and
pillow/ cushion should be placed under the
knee and neck. This will make him relaxed
and keep back flat.
◦ In prone position (lying face down) a cushion
should be placed under the hips and ankle.

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Lubricant:
oils, liquefying creams, powders, or dry hand massage
techniques which are used to help hands glide/ slide easily
over the skin and reduces pulling on body hair without causing
more friction.
Massage oil including vegetable and mineral oils
◦ peanut and almond oils are among those favored by massage
therapists.
Massage powders are also uses in different massage
techniques.
◦ Body powder, Rosemary, Sigina, Lavender, and baby powder are
those powder uses to massage. Powder used for gliding and also
protect from foot fungus.
Dry massage (Dry hard massage) is widely used in Russian massage
techniques (especially for sport massage).

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Precaution in using Lubricants
While massaging competitive sports men care should be
taken not to use oils that contain banned substances in it.
◦ Because, some oils may be absorbed through the skin that the
athlete will be disqualified due doping.
Do not use either too little or too much oils on the skin
with a lot body hair;
◦ because too little oils irritate the hair follicles, whereas too much
oils prevent control.
Avoid spreading the product directly on the recipient’s
body instead spread and warm the substance first in your
hands.
Do not use a product to which the recipient may be
allergic.
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Timing:
a whole body massages excluding the
head & face usually talks about 1 hour. If
it includes the face and the head it takes 1
& half hours.
If you have limited time constraint on just
two or three body areas rather than the
whole massage.
E.g. the quickest way to relax someone is
to massage the shoulder, head, and face.
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Positioning and draping the client
during massage
Positioning:
It depends up on :
◦ the aim of treatment
◦ the parts to be assessed or treated
◦ client’s preference and comfort ability.

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The working position/ Posture
Make sure your position is comfortable to
you and you are able to stay balanced for
all the movements you need to take.
Proper posture and body position used
for:
◦ Prevent masseurs from any problems such as
back aches.
◦ Prevents oneself from being tiered so easily
and make it almost effortless.

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If you are working on the massage couch keep your feet
apart side by side or one foot ahead of the other with your
knees slightly flex.
Face the direction of the stroke and never stay in one side
i.e. face the head when working up the body and face
across the body when working across.
If you are working the floor adapt one of the following
positions:
◦ Kneel with your knees apart
◦ Sit cross legged
◦ Have one knee on the floor (to the side of the recipient’s waist)
and the other one up with that foot on the floor. (blow the arm pit
of the recipients)

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Positions for various muscles:
Prone position-
Recommended for :
◦ Posterior neck muscles
◦ Upper and lower basic muscles
◦ Gluteal region
◦ Back of thigh and leg
Supine position-
Recommended for:
all muscles of head and neck, pectorals, arm, abdominal, quadriceps
and anterior compartment of leg.
Seated upright- upper trapezius
Seated inclined- Muscles of the posterior aspect of the head and neck.
Muscles of the upper back
Muscles of the posterior aspect of the upper arm

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Draping vs Undraping
Draping should place the client in safe
warm and comfortable position to receive
the desired massage.
Proper draping exposed only the part of
the body to be massaged
It also avoid possible physical discomfort.
the room temperature determines how
heavily you will drape your partner
(client)
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Undraping Rules:
One part should be undraped at a time
Undrape only those areas which have to be
treated.
Gluteal cleft, perineum, genital and female
breast should not be undraped.(i.e ..should be
draped)
Infant under the age of two years may be
treated undraped.
sheets, towels, pillows and blankets could be
used for draping purpose.
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 Chapter four
Classification of Common Massage and
Their Application

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There are more than 250 variations of
massage techniques
many practitioners utilize multiple
techniques.
Massage can be divided by system, form,
type, method and technique
(classification).

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Classification of Massage
Based on Systems:
◦ European system (Swedish, Russian, French )
◦ Eastern system (Asian)

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Classification of Massage
Based on methods of application:
(a) Hand massage
(b) Apparatus massage
(c) Combine (Hand and apparent)

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Classification of Massage
Based on form
(a) Full massage
(b) Regional massage

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Classification of Massage
Based on benefit
Health Massage
Therapeutic Medical Massage(TM)
Sport Massage
 Cosmetic Massage
 Self massage
 Thai massage

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Health Massage:
Incorporating the most familiar Swedish and
Russian based techniques to relaxes the entire
body.
It benefits the nervous, circulatory and
musculoskeletal systems, and promotes a
general sense of psychological well-being.
It may be conducted with lubricants or dry
massage and required from 45 minutes to an
hour.

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Therapeutic Medical Massage
It is a type of massage relating to the
treatment of disease and curative process.
It served or performed to maintain health.
It requires a firm background in
pathology and utilizes specific treatments
appropriate to working with disease, pain
and recovery from injury.

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Sport Massage
It is is designed to enhance athletic
performance and recovery
It works specific muscle groups used in
exercise to increase muscle tone,
flexibility and reduce the likelihood of
injury.

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Cosmetic Massage
Itis used to increase circulation to the
skin and enhance muscular flexibility, this
improves skin tone and appearance.
Mostly it is it used to treat the face, head
and neck

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Self Massage:
It is usually the
◦ simplest,
◦ cheapest, and
◦ most effective treatment for muscle knots.
Most self-massage strokes use very little pressure and
the hands do not slide over the skin. Instead they move
and stretch the skin to stimulate flow of lymph through
the lymphatic capillaries that are located just under the
skin.
It is also known as lymphatic massage
Its primary purpose is to improve the flow and drainage
of lymph by stimulating the lymphatic vessels.
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Thai massage/ Thai bodywork
Quite different techniques are used to apply twists and
stretches, and these resemble a kind of applied yoga.
Thai bodywork starts in the supine position lying on
the hack - and then each side is worked. This is
followed by the prone position lying face downwards -
and the sequence finishes in the sitting position.
The routine always begins with the feet, which are
subjected to a variety of presses, stretches and flexion.
The legs are systematically positioned through a range
of postures that present the energy channels to their
best advantage.

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Those who receive Thai body work regularly
will experience feelings of relaxation, peace of
mind, happiness, flexibility and youthfulness
In order to give and to receive Thai bodywork,
you will need a partner
avoid working with anyone who is much
heavier than yourself
should be no disturbances or excessive noise,
Throughout the massage your partner should
breathe normally
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Acupuncture

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Acupuncture Therapy
it involves the insertion of very thin needles
through the patient's skin at specific points on
the body - the needles are inserted to various
depths.
it does have some therapeutic benefits, but
not scientifically proven.
According to traditional Chinese medical
theory, acupuncture points are located on
meridians through which give vital energy
runs.
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Acupuncture treatment
Acupuncture generally involves several weekly or fortnightly
treatments.
Most courses consist of up to 12 sessions.
Most sessions last about 30 minutes.
The patient will be asked to lie down, either face-up, face-down or on
his/her side, depending on where the needless are inserted.
The acupuncturist should use single-use disposable sterile needles. As
each needle is inserted the patient should feel them, but initially
without pain. However, when the needle reaches the right depth there
should be a deep aching sensation.
Sometimes the needles are heated or stimulated with electricity after
insertion. Once inserted, the needles will remain there for about twenty
minutes.
Acupuncture practitioners say that the stimulation increases blood flow
while at the same time triggering the activity of our own body's natural
painkillers, nerves, muscles and connective tissue can be stimulated.
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Basic Techniques of Massage
Skill of massage can be developing
through continuous practice.
Effectiveness of massage technique is
also depends on the masseur correct use
of his feet, leg, pelvis, shoulder elbow and
hands.
Effleurage,Petrissage,Tapotement,
Friction and vibration.

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1. Effleurage
It consists a long, soothing, stroking movements
performed by palmer aspect (cover the large area)
of fingers (over the small area) of one or both
hands.
Effleurage is used to start of any type of massage,
soothing the nerve endings and again at the end of
massage.
It means every soft tissue manipulation techniques
starts and ends with the effleurage. Effleurage can
be performed with one hand, both hands, the
thumb and with the tips of fingers.
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Classification of Effleurage:
SuperficialEffleurage
Deep Effleurage

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Superficial Effleurage:
Superficial effleurage (Longitudinal stroke) for back region
Position of the client:
◦ Prone laying the whole back should be exposed fully. An extra care should be given in case of
female client.
Position of the Masseur:
◦ Standing at the side of client, with one foot slightly behind but in line with the other allows shift
the body weight forward and backward.
Procedure:
◦ both hands are placed on the lower back region and the hands are kept relapsed throughout the
movement.
Both hands move longitudinally form just above the sacrum to the umbra, thoracic and
axilla.
After completing stroke at the axilla hands are returned back to the original position
from axilla to the lateral wall of thorax.
When hands return, pressure is not applied but fingers maintain contact with the skin
through the return stroke.
Again the hands are positioned on the lower back region and prepare for another stroke.
Every stroke of effleurage should be in steady rhythm and may take 6 seconds.

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Reverse longitudinal stroke of superficial
Effleurage
Position of client: Prone lying
Position of masseur: Standing at the head, end of the
treatment table.
Procedure:Similar procedure applied as longitudinal stroke
for back region.
Five to ten repetitions of strokes are performed. Repetition of
strokes may increase if these are performed over larger
muscles,
The purpose of effleurage in general drain the fluid, so that
strokes of effleurage are performed from distal or proximal
part of the lymph nodes, from these it is taken out to the
heart, thus the effleurage helps reducing the swell or effusion.

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Deep Effleurage
It is deep actions aimed apply reinforced
hand for deeper pressure. If more pressure is
required the dorsal surface of hand or wrist is
rein-informed by the other hand. Mainly its
strokes are circular, parallel to the long axis
of muscle or muscle group may also be
performed on whole back region.
Mainly deep effleurage can be applied, on
whole back region on neck, and upper back
and deep effleurage with thumbs.
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Deep massage On whole back region:
Position of masseur and c
◦ lient: Same as longitudinal superficial
effleurage.
Procedure:
◦ The procedures also remain same as
longitudinal superficial effleurage, but in the
technique more pressure is applied than the
previous techniques.
To apply more pressure one hand may be
re-inforced by other hand.
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Deep massage On neck and upper
back
Position of the masseur: Standing at the
head, end of the treatment table.
Procedure: Both hands are placed on the
posterolateral aspect of the neck.
As the hands approach axilla, pressure is
released gradually and hands are return
for next stroke with little contact with the
skin.

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Deep effleurage with thumbs:
Position of the client: Prone lying.
Position of the masseur: Standing at the side of client.
Procedure: Both hands are placed over the muscle which
is being manipulated.
The pressure is applied through the thumbs by learning
slightly forward.
The hand and fingers may also move with the thumb but
pressure is applied only by the thumb.
Over treating an area can cause hypersensitivity.
The procedure may also be performed with single thumb.
 

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Difference between superficial and
deep effleurage
Superficial effleurage Deep effleurage

Contact Whole relaxed palmar Whole relaxed palmar surface of hand often
surface of hand reinforce on the wrist or proximal forearm,
sometimes thumb
Pressure Light Light to heavy

Engages Skin, superficial fascia Muscles and associated tissues

Direction On limbs-centripetal, on Circular, parallel to the long axis of muscle

torso-towards axillary or or muscles group
inguinal lymph nods

Rate 5-50 cm/sec 12-25 cm/sec

Duration 3 min or longer 20-60 Sec. or more

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Therapeutic effects of Effleurage:
Increases lymphatic and venous return
from the region to which it is applied to
the heart
Dilates the superficial arterioles

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Cautions:
◦ Acute cardiac condition, and Congestive
heart failure
Contraindication:
◦ Acute orthopedic injuries
◦ Newly forming scars
◦ Infected area
◦ Hypo and hyperthermia
◦ Open wound, burn and ulcers.

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2. Petrissage
Itis techniques of soft tissue manipulation
which includes various types of strokes in
which tissue are compressed, lifted,
squeezed and released varying amount of
pressure, drag and glide.
Various types of strokes are performed to
mobilize skin, subcutaneous tissues and
deep structures like muscles.

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Classification of Petrissage
Kneading: Palmer, Finger pad, Thumb
pad, Knucle and Reinforced
Picking up
Wringing
Skin rolling

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Classification of Kneading:
kneading is classified on the basis of the part of
hand which is used to deliver the pressure,
example-when the whole palm of hands are used
to deliver the pressure this kneading named as
palmar kneading.
◦ Palmar or compression kneading
◦ Finger pad kneading
◦ Thumb pad kneading
◦ Kunckle kneading
◦ Reinforced kneading
◦ Squeeze kneading.
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Therapeutic Effects of Petrissage:
Increases blood supply of muscles, which eliminates the waste
metabolic product thus:
Relaxes the muscles and, Increases flexibility of muscles
Increases extensibility and elasticity of skin and subcutaneous
tissue.
increase extensibility and mobility of connective tissues.
increases joint range of motion (ROM).
Increase lymphatic blood flow.
To reduce anxiety, stress and improve relaxation.
To alleviate the behavioural symptoms of depression
hyperactivity.
To decrease chronic edema.
To decrease pain during labour.

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Contraindications
Acute inflammation.
Infection.
Confirmed or suspected thrombosis
Osteoporotic patient /suspected patients
for those who take anticoagulants.
Malignant disease.
Acute musculo-skeletal injuries, fracture,
muscle strain, ligaments sprain

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3.Tapotement or percussion
It is a technique of soft tissue manipulation in which
the part which is being treated strikes repeatedly by
the various modified positions of hands.
In all tapotement movements the fingers, hands and
wrists should be as relaxed as possible.
Tapotement strokes are fast, precision action,
bringing one hand quickly after the other in to
contact with the patient’s body.
After few strokes of tapotement the masseur must
ask the patient (client) whether the pressure which
is being delivered by hands is comfortable or not.

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Classification of Tapotement

clapping
Beating
Hacking
Pounding

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Cupping

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Beating

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Hacking

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Pounding

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Therapeutic Effects of Tapotement:

Various forms of percussion have different

therapeutic effects.
Clapping when performed on posterior chest
wall and lateral wall ,facilitates airways
clearance
hacking stimulates sensory nerve endings and
causes contraction of the muscles.
In cardio-pulmonary physiotherapy, percussion is
combined with postural drainage and is followed
by or alternately with vibration of rib cage.

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Contra-indications:
Rib fractures.
Untreated tension pneumothorax.
Confirmed or possible coronary thrombosis.
Pulmonary embolism.
Unstable cardiac condition.
Spastic muscles
Acute traumatic oedemia
Cancer or tumors.

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4. Friction
Friction involves brisk, repetitive, specific,
compressive strokes which are delivered by hand, tip
of fingers, or thumb on the skin.
Movement in to a joint is the key to friction. The skin
moves with the hand or tip of fingers over the
underlying structures (ligamentous, tendons or
muscle).
In superficial friction massage skin does not move
with hands. The techniques of friction massage are
classified on the basis of direction and amount of
force that is applied.
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Classification of Friction
Superficial friction massage
Deep friction massage

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Indications:
Tendinitis
Fascitis
Ligamentous injurie
Trigger points

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5. Vibration
Vibration is a soft tissue manipulation technique
in which fine shaking strokes are performed over
the patient’s body by single or double hands.
Basic technique-To perform vibration technique
single or both hands are placed over the patient's
body, then rhythmic, vibrating strokes are
delivered from in and out, up and down manner.
When technique is performed on the lateral and
posterior chest wall to loosen lung secretions,
strokes should be delivered during the expiratory
phase of the respiration.
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Indications:
Chronic obstructive pulmonary disease (COPD)
Before and after operation to clear the secretion
from lungs
To reduce chronic oedema.
Contra-Indication
 Severe rib fractures
 Hyperreflexia
 Acute pulmonary embolism
 Hypertension
 Spasticity.

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Summary
No Basic massage technique Classification Sub-Classification
1 Effleurage 1. Superficial - Longitudinal stroke for back
2. Deep region
- Reverse longitudinal for back
region
2 Petrissage 1. Kneading - Palmer kneading
2.Picking up - Finger pad kneading
3. wringing - Thumb pad kneading
4. Skin rolling - Knucle kneading
- Reinforced Kneading
3 Tapotement 1. Clapping
2. Beating
3. Hacking
4. Pounding
4 Friction 1. Superficial - Deep transverse friction
2. Deep - Circular deep friction
5 Vibration

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 Chapter Five
Sports Massage

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Sport massage
It has become an integral part of a training .
Large number of trainers believe that massage can provide an
extra edge to the athletes who participate in high
performance sports.
Massage has become a necessary ingredient for a complete
workout.
The physiological and psychological benefits of massage
make it an ideal complement to a total conditioning program.
Anyone who routinely stretches their physical limits through
movement can benefit from a massage.
Incorporating massage in your conditioning program has
many benefits.

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The Benefits of Sports Massage
 reduce the chance of injury, through proper stretching
and event preparation, and through deep tissue massage;
 improve range of motion and muscle flexibility,
resulting in improved power and performance;
 shorten recovery time between workouts;
 maximize the supply of nutrients and oxygen through
increased blood flow;
 Enhance elimination of metabolic by-products of
exercise.
 Assists recovery (whole or special body area)
 Avoids overtraining
 It helps for good shape faster, and with less stiffness and
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Sports Massage Techniques
Each sport and athletic event uses muscle groups in a different
way. Sports massage therapists must be familiar with each
muscle, the muscle groups and how they are affected by the
specific movements and stresses of each sport.
They also are trained in the appropriate uses of hydrotherapy
and cryotherapy.
Traditional western (e.g. Swedish) massage is currently the
most common approach used for conditioning programs.
It is frequently supplemented by other massage therapy
approaches including deep tissue, trigger point work, and
acupressure.
Some massage therapists have special training in sports
massage and greater experience working with athletes.

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Sports massage therapy frequently
includes the use of one or more of the
following techniques:
Deep Swedish Massage
Compression Massage
Cross-Fiber Massage
Trigger Point/Tender Point Massage
Lymphatic Massage

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Deep Swedish Massage
Muscle-specific applications of the standard effleurage, petrissage, vibration, and tapotement
techniques.
Compression Massage
Rhythmic compression into muscles used to create a deep hyperemia and softening effect in
the tissues. It is generally used as a warm-up for deeper, more specific massage work.
Cross-Fiber Massage
Friction techniques applied in a general manner to create a stretching and broadening effect
in large muscle groups; or on site-specific muscle and connective tissue, deep transverse
friction applied to reduce adhesions and to help create strong, flexible repair during the
healing process. 
Trigger Point/Tender Point Massage
Combined positioning and specific finger or thumb pressure into trigger/tender points in
muscle and connective tissue, to reduce the hypersensitivity, muscle spasms and referred pain
patterns that characterize the point. Left untreated, such trigger/tender points often lead to
restricted and painful movement of entire body regions.
Lymphatic Massage
Stimulation of specialized lymphatic-drainage pathways, which improves the body’s removal
of edemas and effusion.

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How Does Massage Help?
Recovery- Therapeutic massage helps the body recover from the stresses of strenuous exercise, and
facilitates the rebuilding phase of conditioning. The physiological benefits of massage include improved
blood and lymph circulation, muscle relaxation, and general relaxation. These, in turn, lead to removal of
waste products and better cell nutrition, normalization and greater elasticity of tissues, deactivation of trigger
points, and faster healing of injuries. It all adds up to relief from soreness and stiffness, better flexibility, and
less potential for future injury.
In addition to general recovery, massage may also focus on specific muscles used in a sport or fitness
activity. For example, areas of greater stress for runners and dancers are in the legs, for swimmers in the
upper body, for tennis players in the arms. These areas are more likely to be tight, lose flexibility, and
develop trigger points.
Over-training- Adequate recovery is also a major factor in avoiding the over-training syndrome. Over-
training is characterized by irritability, apathy, altered appetite, increased frequency of injury, increased
resting heart rate, and/or insomnia. It occurs when the body is not allowed to recover adequately between
bouts of heavy exercise. Therapeutic massage helps you avoid over-training by facilitating recovery through
general relaxation, and its other physiological effects. 
Trouble spots. . . You may also have your own unique trouble spots, perhaps from past injuries. A massage
therapist can pay special attention to these areas, monitor them for developing problems, and help keep them
in good condition. An experienced massage therapist can also compliment treatment received from other
health care professionals for various injuries. You may also have your own unique trouble spots, perhaps
from past injuries.
A massage therapist can pay special attention to these areas, monitor them for developing problems, and help
keep them in good condition. An experienced massage therapist can also compliment treatment received
from other health care professionals for various injuries. 

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Three Areas of Sports Massage
Sports massage may involve prevention
and maintenance programs, on-site
treatment before and after an athletic
event, and rehabilitation programs for
those who are injured during the program.
Maintenance Massage
Event Massage
Rehabilitation Massage

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Maintenance Massage
An effective maintenance program is based on the
massage therapists understanding of anatomy and
kinesiology, combined with an expert knowledge of which
muscles are used in a given sport and which are likely
candidates for trouble. By zeroing in on particular muscle
groups and working specific tissues, the sports massage
therapist can help the athlete maintain or improve range of
motion and muscle flexibility. The overall objective of a
maintenance program is to help the athlete reach optimal
performance through injury-free training.
embolize.
 

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Event Massage
Pre-event-
Pre-event sports massage is given within the four hours preceding an event to improve
performance and help decrease injuries. It is used as a supplement to an athlete's warm-up
to enhance circulation and reduce excess muscle and mental tension prior to competition.
It is normally shorter (10-15 minutes) than a regular conditioning massage, and focuses on
warming-up the major muscles to be used, and getting the athlete in a good mental state
for competition. It also improves tissue pliability, readying the athlete for top performance.
Certain massage techniques can help calm a nervous athlete, and others can be
stimulating. 
Inter/Intra-event
Inter- and intra-event massage is given between events or in time-outs to help athletes
recover from the preceding activity, and prepare for the activity coming up. It is also short,
and focuses on the major muscles stressed in the activity.
Post-event
Post-event sports massage is given after a competition and is mainly concerned with
recovery. It is geared toward reducing the muscle spasms and metabolic build-up that
occur with vigorous exercise. Recovery after competition involves not only tissue
normalization and repair, but also general relaxation and mental calming. A recovery
session might be 15 minutes to 1&1/2 hours in length.

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Rehabilitation Massage
Even with preventive maintenance, muscles cramp, tear, bruise, and
ache. Sports massage can speed healing and reduce discomfort
during the rehabilitation process.
Soft tissue techniques employed by sports massage therapists are
effective in the management of both acute and chronic injuries. For
example, adding lymphatic massage to the "standard care" procedure
in the acute stage of injury will improve control of secondary,
hypoxic injury and enhance edemous fluid removal throughout the
healing cycle.
Trigger point techniques reduce the spasms and pain that occur both
in the injured and "compensation" muscles. Cross-fiber friction
techniques applied during the sub acute and maturation phases of
healing improve the formation of strong and flexible repair tissue,
which is vital in maintaining full pain-free range of motion during
rehabilitation.

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In all cases, such massage techniques are
employed in collaboration with other
appropriate medical care. For example,
encouraging circulation around a bruise, but
not directly on it, through the use of
compression, cross-fiber techniques or even
long, deep strokes is only used after
appropriate medical referral and diagnostics
indicate that there are no clots formed in the
area which may embolize.
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