Massage Theory

Stroke	Purpose/Uses	Mechanical effect	Reflexive effect	Contraindications
LIGHT EFFLEURAGE Gliding, Fanning, Tree branching, shingling etc.	Transitioning Spreading oil Evaluating tissue		Relaxes muscles (parasympathetic nervous system) Relieves pain (Gate control theory, endorphins)  Increases arterial and capillary circulation  Increases vasodilation (slowing heart rate and blood pressure)	Hyperesthesia  Marked or pitted edema  Gross swelling Open wounds distal to inflammation or infection
DEEP EFFLEURAGE Knuckling,		Increases venous and lymphatic flow removing wastes, reducing edema  Improves nutritional status of tissues  Increases arterial and capillary circulation, bringing nutrients  Warms superficial tissue  Desquamation of dead skin	Same as above  Deeper muscle relaxation  Capillary dilation longer lasting	Same as light effleurage  Very hairy skin  New scar tissue  Venous stasis
PETRISSAGE Picking up, wringing, kneading, open C/closed C, alternating thumb, squeezing, lifting, skin rolling (lifting tissue away from underlying structures)	Used after effleurage  Relieves congestion  Reduces swelling  Digestive disorders   Muscle shortening   Spastic paralysis  Fatigue	Stretches muscle fibers and stimulates muscle tone, broadens fibers  Breaks up adhesions  Increased circulation and waste elimination  Moves interstitial fluid	Slow-relaxes nervous system  Fast-stimulates NS  Increases glandular activity of skin  Increases peristalsis when done over abdomen  Affects proprioception	Atrophied muscles  Flaccid paralysis  Acute inflammation
DIRECT PRESSURE FRICTION Compression	Use after tissues have been warmed up  Hypertonic muscles  Treatment massage  Deep tissue work	Compresses and spreads tissue  Temporary ischemia  Mobilizes muscle/tendon junction	Reduces pain and spasm  Hyperemia  Increases peristalsis when done over abdomen	For all frictions:  Acute inflammations  Neuritis  Recent injuries  Osteo and rheumatoid arthritis-especially acute stages  Muscles lacking innervation(paralysis)  Debilitating neuromuscular dysfunction such as MS, ALS, MD.
LINEAR OR CIRCULAR FRICTION	same as above	Myofascial releasing-separating adhered fascial planes  Broadens and stretches muscle fibers  Increases muscle	Decreases tension through stimulating Golgi tendon reflex Increases circulation Creates hyperemia
Cross fiber friction	Use only after a thorough warming of involved tissue Apply at right angles to scar/fibrotic tissue  Superficial tissue must move over underlying structure  Apply frequently enough to have an impact	Breaks up adhesions  Assists in realigning scar tissue	Relaxes muscles by stimulating Golgi tendon reflex
Heat rub friction		Heats skin  Warms tissue	Vasodilatation  Relaxes muscles
TAPOTEMENT Tapping, Pincement, Slapping Hacking, Cupping, Beating, Pounding	Stimulation of tired muscles  Relaxation of hypertonic muscles	Loosens mucus in thoracic cavity	Stimulates nervous system, muscles, vessels  Enhances muscle tone via contract-relax response  Increases circulation  Stimulates organs through low back  Increases gaseous exchange  Stimulates skin and glandular activity	Muscles is spasm or cramping  Spastic paralysis  Atrophied muscles  Flaccid paralysis  Insomnia, neurasthenia or complete exhaustion  Neuritis or painful conditions  Over bony area  No heavy tapotement over the kidneys  No heavy tapotement over low back in pregnancy or menstruation
FINE VIBRATION Static or moving	Relaxation		sedates nervous system  reduces pain(gate theory)  relaxes muscle	same as tapotement
COARSE VIBRATION Static or moving		loosens ligaments	Penetrating stimulation
JOSTLING/SHAKING		Increases synovial activity  Increases circulation	Stimulates organs  Reduces muscle guarding  Rejuvenating  tired muscles	same as tapotement
SWEDISH GYMNASTICS Active free, active assisted, passive, resistive		Stretches muscles and ligaments  Increases circulation and nutrition  Increases waste elimination  Loosens adhesions  Increases ROM and flexibility	Stimulates NS  Increases blood pressure and temperature	Torn ligament, tendon or muscle  Unhealed fracture  Post surgery  Heart conditions  ( active and resistive)  Acute injuries

General Hydrotherapy Applications, Temperatures, Effects of Hot and Cold

1. Local Heat : Applying heat to specific areas of the body such as joints, chest, throat, shoulders, spine: use moist hot compress, hot water bottle, hot pack, heating pad, Thermophore.
2. Local cold: Apply cold to specific area of the body; use cold compress, ice bag, ice pack, ice hat, frozen bandage.
3. Cold compress that heats the body: A cold wet cloth that is in contact with the skin and then covered with a water resistant covering will create a physiological response that warms the body from within.  This is called a cold double compress.  It can be applied to any area of the body or the entire body.
4. Tonic friction: Water sponging or washing combined with some form of friction on the skin produces a tonic effect on the body
5. Sponging: Use alcohol, water or which hazel applied to a sponge to wash the body.
6. Baths: Body is immersed in cold, hot or tepid water.  Any part of the body may be bathed; arm bath, eye bath, finger bath, hand bath, foot bath.
7. Showers: Many kinds of water streams can be directed against the body.
8. Steam: Water particles dispersed through the air that affects the skin, lungs and air passages. Cold steam moistens dry rooms in winter and can help prevent colds and sinus headaches.  Hot steam increases body temperature and perspiration to release toxins.
9. Sauna: Dry heat which increases body temperature and increases perspiration;  May put strain on nasal and lung passages.
10. Shampoo:  Soap and water used on one or all parts of the body

Temperatures for Hydrotherapy Treatments

 

Hydrotherapy Effects of Cold and Hot Water

	Primary Effect	Secondary Effect
Cold Water	-peripheral vascular constriction -Pallor of skin, chilliness, shivering, chattering -Increases respiratory rate -Increases muscular tone -Increases blood pressure and heart rate	Occurs if you warm up: -Peripheral vascular dilation, causing redness of skin -Decrease in respiratory rate -Decrease in blood pressure and heart rate -Muscle relaxation
Hot Water	-Increases Body Temperature -Increases Pulse rate (by 10 for every 1 degree increase in body temp) -Increases respiration rate -Increases oxygen consumption and metabolic rate -Peripheral vasodilatation -Increases Circulation -Decreases blood pressure -pH becomes more alkaline -Increases in excretion from kidneys	Generally the same as secondary effects of cold;  Gradual reduction of these effects as body returns to normal.

 

General Therapeutic Effects of Cold:

Reduces muscle spasm by breaking the pain-spasm-pain cycle.

Reduces spasticity when muscle temperature is reduced. Used to move muscles so that they can be reprogrammed to increase motor skills as in subacromial bursitis.

Relieves pain through its direct effect on nerve fibers and receptors

Reduces Inflammation in the early phase

Reduces swelling an edema in the acute phase

Secondary effect of cold is heat ad body restores normal temperature

Types of cooling:

Convective: blowing air over skin

Evaporative: removal of heat by using ethyl chloride sprays

Conductive: contact with cooled substances such as ice packs or compresses

Application Times:

Application times must be adjusted to reach the area to be treated. Ligaments need more time because of the depth and type of collagen fibers.

Times must be adjusted according to the size of the injured area, the nervous system sensitivity and the amount of adipose tissue present.

Start with a minimum of about 5 minutes and check to see how cold the area is.

It also depends on what source of cold you use- straight ice in zip-lock or gel packs.

Contraindications:

Impaired or compromised circulation – diabetes, peripheral artery disease

Previous frostbite or other hypersensitivity to cold such as Raynaud’s disease or Lupus

Poor kidney function

Hypothyroidism – causes further reduction in basal metabolic rate

Advanced Cardiovascular disease because of increase in systolic blood pressure

Slows wound healing by slowing cell metabolism

Open wounds, rashes

Hypertension – may temporarily increase blood pressure

Very young or very old – may have impaired regulatory systems and limited communication

Cold allergy or sensitivity

Adverse Effects of Cold:  burns when temperature is below 59 degrees F.

General Therapeutic effects of Heat:

• Increases the extensibility (ability to stretch) of collagen fibers
• Decreases chronic joint stiffness
• Increases range of motion
• Relieves pain
• Relieves muscle spasm
• Increases blood flow
• Can assist in removal of edema and waste products from areas of injury

Transmissions of Heat:

• Conduction: contact with warmed substances such as hot packs, paraffin
• Radiation: luminous and infrared lamps
• Conversion: Heat produced as energy from high frequency currents such as ultrasound; penetrates to deeper layers of body

Indications/Applications:

• Joint contractures to stretch tendons and increase flexibility; Heat and stretch fibers
• Rheumatoid Arthritis- heat increases the viscosity of the synovial fluid in the joint. Heat and follow with ROM exercises
• Chronic muscle spasm

Contraindications:

• Any acute inflammation such as bursitis, arthritis, tendonitis, sprains or strains
• diabetes
• Deep vein thrombosis
• impaired circulation or reduced sensation
• congestive heart failure
• acute injury, inflammation and edema
• Pregnancy – no immersion baths or hot packs to the abdomen
• Very young and very old may be unable to communicate
• Open wounds, rashes or previous burns

Adverse Effects of Heat

Burns – keep temeratures below 113 degrees, use insulation between the heated object and the skin, use heat packs that cool down.

Fainting –  usually due to lack of blood and oxygen to the brain from peripheral vasodialation, change in body positions that cause a change in blood pressure.