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Massage
- 1. THERAPEUTIC MASSAGE - FOR PHYSIOTHERAPIST DR. MEGHAN A. PHUTANE (PT) CARDIORESPIRATORY PHYSIOTHERAPIST
- 2. INTRODUCTION
- 3. The word ‘Massage’ comes from the Arabic word ‘mass’ denoting ‘to press’. 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.
- 5. MECHANICAL EFFECTS Removes dead cells. Allows sweat glands, hair follicles & sebaceous glands to be free of obstruction & function better. Increases lubricant 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,
- 6. 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
- 7. PHYSIOLOGICAL EFFECTS – NERVOUS SYSTEM Spinal motor neuron excitability of spinal reflex pathways is reduced due to decreased H-reflex. Inhibitory influence on ά motor neuron excitability but no carryover effect. Releases endorphine – reduces chronic pain
- 8. PHYSIOLOGICAL EFFECTS – MS SYSTEM Affects muscle fatigue Affects degree of muscle tone
- 9. 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
- 10. 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
- 11. CONTRAINDICATIONS - RELATIVE Older people Those with fragile skin Early stage of osteoporosis Children Adults with learning &/or physical disabilities People recovering from infections & bone #
- 13. EXAMINATION OF PATIENT Assessment Subjective Objective History, onset, behavior, nature, intensity, aggravating & reliving factors, clinical features Plan objective components Observe & measure the functions Posture, ROM, activity level, muscle power, balance, coordination, gait, ADL, palpation, muscle problem
- 14. ASSESSING FINDINGS Examination – assess findings – plan treatment according to indications & contraindications.
- 15. CLINICAL REASONING Types of clinical reasoning – Hypotheticodeductive (form hypothesis) Pattern recognition (comes with experience – integral part) Narrative (express in their terms) Predictive (estimate outcomes)
- 16. DETERMINE INDICATIONS Decision to apply massage & to select particular techniques – based on examination Observation & palpation (tissue response, end feels) Determine nature of tissue glide (eg. Loss of elasticity – kneeding, picking up; stiffness – skin rolling)
- 17. MEASURING CHANGE & OUTCOME MEASURES HR, BP, RR, EMG, mood & anxiety measures, pain, vital capacities, joint ROM, spasm, swelling/ oedema, proprioception, ADL’s
- 18. PALPATION & SKILLS Palpation should be repeatable, reliable & valid. Attention to patients & physiotherapist position, ensuring hands are accurate, sensitive & testing what is claimed. Decide accurately when to apply massage & when not to apply.
- 20. Check before starting massage that – Reach all the body parts Stand in walk or lunge standing Change position without hesitation if needed
- 21. 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)
- 22. HAND EXERCISES Stretching of fingers Abduction of fingers Prayer pose Reverse prayer pose
- 23. RELAXATION Relaxation of hands – important to keep in full contact with patient & mold to the shape of the body. Natural rest position – thumb & fingers slightly flexed & a little apart Relax whole arm – needed for some manipulations Practice relaxation prior to learning massage – good method is reciprocal relaxation Co-ordinated & integrated movements of body without fatigue & physical stress are important.
- 24. 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
- 25. 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)
- 26. ALLERGIC REACTIONS Some contact medium might cause mild to severe allergy Check allergic response before use Eg. Nut & wheat content
- 27. 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
- 28. 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
- 29. EXAMINATION OF PART As described previously Look at skin state (dry/ oily/ wet/ hairy) (bruises/ abrasions/ lacerations). The feel
- 30. TICKLISH SUBJECTS 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.
- 31. MANIPULATIONS
- 32. MASSAGE MANIPULATIONS EFFLURAGE/ STROKING MANIPULATIONS PETRISSAGE MANIPULATIONS * Kneading * Picking up * Wringing * Rolling * Muscle shaking FRICTION MANIPULATIONS * Circular * Transverse PERCUSSIVE MANIPULATIONS * Hacking * Clapping * Vibrations * Beating *Pounding * Tapping