Massage
Terms
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- CFM Indication Examples
- Supraspinatus at musclo-tendinous junction; Long head of biceps; Carpal tunnel syndrome; Oblique abdominal muscles; Psoas at lower musculo- tendinous junction; Quadriceps expansion at the patella; Adductors of thumb
- Types of Massage Techniques
- Effleurage (stroking), Petrissage (kneading), Friction, Tapotement (Percussion)
- Patient Preparation
- Check nail beds and skin condition prior to beginning; First, explain what you will do and the patient if the position is comfortable for them; Make sure all body parts are well supported, using pillows if needed; Elevate edematous extremities as needed; Remove restrictive clothing and fully expose the area to be treated; Drape the patient appropriately: patient modesty should always be your top priority
- Direction
- Massage is applied in a centripetal motion, that is toward the heart; Usually follows the direction of the muscle fibers: what is the exception? Cross Friction Massage; Clear the proximal segment first, and then move distally; Massge in an area should be distal to proximal; Typical rule is stroke x3, knead x2, stroke x3 in each area
- Palmer Effleurage
- This is a more superficial technique; Hnads are kept relaxed and pressure is exerted through palms; Use of body weight to apply pressure (weight shift) decreases work on PTA; Make sure to continually ask about the pressure to monitor patient comfort
- Active Trigger Points
- Hyperirritable at rest and with motion; May have autonomic response (sweating, nausea, etc); Encourage to move through full ROM to maintain muscle length and strength
- Alternate Two-hand Kneading
- Similar to fulling, but tissues are picked up between the therapist's hands
- Background
- Based on ancient Chinese treatment to utilize "energy pathways" or meridians; Meridians can be accessed at 15 paired points along pathway-trigger points (train tracks through the body with stations at 15 locations); Meridians are pathways that link internal organs with point of irritation
- Latent Trigger Points
- Only sore with palpation; May last for years
- CFM
- Typically Used at muscle tendons and ligaments; To treat primarily chronic tendon inflammations and adherent tissues; Can be used for acute and subacute conditions; Goals; Indications; Contraindications; Procedure
- Powder
- Easy to apply and inexpensive; Good for oily skin; Poor contact for petrissage and bad for patients with respiratory problems
- Slapping
- Palm of hands
- Petrissage (kneading) used to:
- Stretch connective tissue; Hasten removal of waste products from muscles; Promote superficial and deep circulation
- Indications for Massage
- Amputations: decrease edema; Arthritis: pain control; Bursitis: decrease edema; Myositis: increase comfort; Facial Paralysis: Stimulate circulation around the nerve site; Insomnia: relaxation; Postural Dysfunction: stretch muscles; Prolonged bedrest/decubitus ulcers: stimulate circulation to pressure areas; Scar Tissue/contractures/burns: Soften collagen (only works on superficial scar tissue); Non-obstructive edema
- Effleurage is used to:
- Facilitate capillary circulation; Increase venous blood and lymph movement to move fluid out; Increase arterial circulation to provide nutrition to the area
- Mineral Oil
- Good for effleurage and petrissage; Good for dry skin; irritates oily skin; Stains clothing and hard to clean up
- Lanolin-based Lotion
- Non-irritating to skin
- Alcohol
- Toughens and dries skin (resifual limb); Removes oily lubricants after treatment; Use with caution because it is cold
- Rhythym and Contact
- Continuous with no break or hesitation; When using unilateral massage, the other hand should rest lightly on the patient or support the part being massaged
- CFM Goals
- Prevent or loosen adhesion formation by improving circulation- Scarring, Burns, Immobilized area secondary to injury; Absorption of localized edema; Reduction of local spasms; Provide deep pressure over trigger points for relaxation
- Friction Used to:
- Stretch adhesions; Loosen scars; Promote absorption of exudates
- What to Remember
- Therapist preparation; Coupled with what other modalities; Patient preparation; Direction; Pressure; Rate; Rhythym and contact; Therapist position; Mediums
- Topeotement
- Hacking; CUpping; Tapping; Beating; Slapping
- Pressure
- Generally begin light, become deeper, end light; Determined by patient and treatment goals
- Tapping
- Similar to typing
- Hand Kneading
- Tissue is picked-up, rolled and compressed in a circular motion between the thumb and ulnar portion of the hand; May be a one- or two-hand technique
- CFM Procedure Frequency
- Intensity is based on acuity of trauma. Cyriax says: Ligaments: 6-12 visits, every other day; Acute muscle belly irritation: 5 min/day; following with gentle AROM; Subacute or chronic muscle belly irritation: Same as ligaments; Acute tendons: 5-10 min/day; follow with 5 min PROM; Chronic tendons: 15-20 minutes, 2 sessions
- Contraindications
- Obstructive edema; Cardiac decomposition/Congestice Heart Failure; Active malignancy: might spread malignant cells; probably ok during end stage disease; Thrombophlebitis: might dislodge embolism; Hematoma; Non-union fractures; Post-operative areas: sutures, grafts, etc; Around lacerations; Active communicable diseases; Mental distrubances: if touch could be misunderstood, don't do it; Acute infections/fever
- Why used before ice?
- Heat first because it increases mobility of the collagenous tissues and gets the blood flowing to the area to aid with waste removal; Before exercise as sort-of a warm-up. Blood is flowing to area and tissues have been warmed up, allowing patient to exercise with more elongated muscles; Ice last to help prevent inflammation/DOMS in tissues that may have been slightly damaged during the massage routine (muscle fibers, tendon fibers, etc)
- Figure-of-Eight
- Place one hand on top of the other and apply pressure through the heels of the hand in a "figure 8" pattern; Usually applied to the low back
- CFM Contraindications
- Inflammation due to bacterial infection; Calcification or ossification within soft tissue; Bursitis ; Traumatic arthritis or elbow articulation (possible myositis ossificans); Over nerve roots (possible compression)
- Therapist Position
- Body weight evenly distributed between both feet to allow easy weight shift; Table should be at a height comfortable for allowing weight shift and fluid transitions between movements; Good posture helps avoid fatigue and backache
- Indications
- Headaches or eyestrain; Sinus problems; Neck and back pain; Stress-related tension (fibromyalgia)
- Mediums
- Purpose is to avoid uncomfortable friction between you and the patient; Lanolin-based lotion (most common); Mineral oil; Powder; Alcohol
- Finger Kneading
- Tissues are compressed between the fingers/thumb and underlying structures; Used when tissue to too taunt to be picked up
- Always begin and end with this
- Effleurage
- Effleurage
- Uses the palm of the hand with fingers together; Long and smooth gliding strokes where hand is contact with skin
- Points to Remember
- Target local trigger points to release endorphins and increase blood flow-->muscle relaxation; Utilize deep, steady pressure for 1-5 minutes per point, per treatment
- Topotement Used to:
- Stimulates the tissues to increase circulation and break-up adhesions
- Rate
- For relaxation, it is slow and uniform; For stimulation, it is fast
- Knuckling
- Used for deep pressure; Pressure through a fisted hand/knuckles that glide along the skin
- Accupressure and Trigger Points
- Localized tender points that radiate; When palpated, patient usually has pain or numbness; Active trigger points (best to palpate in this stage); Latent trigger points; Background; Points to remember; Indications
- CFM Indications
- Muscle sites; Musculotendinous junctions; Tendons; Teno-periosteal junctions; Ligaments
- CFM Procedure
- No lubricant is used so there is no skin shearing; Must be provided tranversely and of sufficient sweep and penetration (3/4 in); When applied to muscle. it must be relaxed for fiber separation and hsould be followed by active muscle contraction; When applied to tendon, it should be in taut position and patient should not move; Use entire UE to get appropriate pressure; Should continue until pain is gone (typically 10-15 min); Can be used in conjunction with ice massage, estim, etc.
- Beating
- Relaxed, half-clenched fists
- Cross Friction Massage
- Deeply penetrating massage over a small area at the site of the lesion
- Cupping
- Hands are partially cupped
- Fulling
- Applies stretch to skin and fascia (typically used on low back); Both hands used to sweep toward and away from one another
- Hacking
- Ulnar border of hands
- Therapist preparation
- Always wash your hands before starting; keep them warm and dry; Remove all jewelry and maintain short fingernails to avoid scratching the patient
- 2-3 Finger Effleurage
- Used for smaller body areas; Similar to palmer effleurage but pressure is exerted through fingertip pads
- Coupled with what other modalities
- Usually follows heat and preceds exercise. Likely used before ice