Exam 2 Flashcards
What is the definition of massage? (Oxford)
The rubbing or kneading of muscles or joints with the hands
De Domenico - “Beard’s Massage”
- certain manipulations of the soft tissue of the body
- these manipulations are most effectively performed with the hands
- producing effects on the nervous system, the muscular system, the respiratory system, and the local and general circulation of the blood and lymph.
PTs/ATs use this kind of massage
Therapeutic massage
Massage as a modality is used to…
bring about physical, physiological, and sometimes psychological changes
Therapeutic Massage
- Promotes stress relief and relaxation
- mobilize various structures
- relieve pain and swelling
- prevent deformity
- promote functional independence
all in a person who has a specific health problem
Recreational Massage
- relieves stress
- promotes relaxation
- general wellness
All in a person who has no definable health problems
Massage Techniques
- Heller work/Rolfing
- Manual lymphatic drainage
- Sports Massage
- Thai massage
- Myofascial Realease
- Rosen Method (developed by DPT)
General Effects of Massage: Cardiovascular System
Circulation
- dilation of superficial vessels via local reflexes
- increase in SV via promotion of venous return
- decrease incidence of DVT
Edema
- increases lymph flow via mechanical pressure
**BP goes up b/c of you (goes down because they relax)
** This has psych, phys, and mechanical effects
General Effects of Massage: Connective Tissue
Decreases pain and improves tissue mobility
This is ALL mechanical
Cyriax
General Effects of Massage: Muscle Tissue & Nervous System
Muscle Tissue - decreases spasm & muscle hypertension
Nervous Systems - decreases pain (you can make them feel better by making them feel worse)
Indications for Massage
Pain Edema Muscle Spasm Trigger Points Insufficiencies of Circulation Contracted Tissue Specific of General Tension
Contraindications for Massage
Can be Absolute or Relative
- severe distress
- systemic edema
- acute conditions (0-48 hrs minimum)
- over recent surgery
- increased circulation is not desired
- contagious skin conditions
- over foreign bodies/sharp bony prominences
- over areas of active bone growth
- over areas of decreased sensation
- tuberculosis diagnosis
- over the pregnant abdomen
Therapeutic Relationship
- implicit agreement regarding the roles of the Pt. and DPT.
- informed consent
- maintain boundaries
Role of Touch
- interaction is both physical an psychological
- helps you to identify the pt. state
- touch can communicate your state of being
How are your hands?
- wash them
- short fingernails
- rings
Positioning of Patient
- support given to natural joint curvatures
- limbs elevated for circulation
- Pt. should not be supporting any part of themselves
- Pt. should be comfortable
Draping
- expose the area you will be treating
- parts not treated should be covered by towel or a sheet
Message Media
Purpose: to avoid uncomfortable friction between hands and skin
- best if unscented/hypoallergenic
- avoid lotions: absorb too quickly
Positioning the Theraptist
If the table disappeared would you fall over?
Face patient to monitor
Basic Massage Strokes
- Effleurage
- Petrissage & compression
- Friction
Effleurage
rhythmic, consistent, stroking
- superficial: reflex effect, calming
- deep: reflex and mechanical effect
- warming of superficial tissues
- information gathering
Petrissage & Compression
intermittent kneading
- may be unilateral, bilateral or digital
- increass circulation
- softens and lengthens tissue
Friction
sustained pressure with movement
- may be linear, cross fiber, circular, scar
- cyriax cross fiber is a particular technique
Other massage strokes
- jostling
- percussion
- direct pressure (sustained w/no movement)
- myofascial release
- trigger point techniques
Principals Regarding Massage Strokes
Direction
Duration
Pressure
Rate & Rhythm
Direction
linear, cross fiber, distal proximal
*don’t go proximal to distal
Duration
take adequate time to achieve goal
Pressure
varies based on intent, body region, pathology, and patient tolerance
Rate & Rhythm
should be purposeful and consistent
Regarding Strokes
- work broad and light -> specific & deep
- mold hands to pt. body
- deep pressure: distal -> proximal
- address entire length of muscle of interest
- minimize interruptions
Lymphatic System Functions
- Remove excess fluids from tissues
- Absorption of fatty acids and subsequent transport of fat to the circulatory system
- Production of immune cells
Lymphedema
an accumulation of high-protein fluid that can collect in any body part, but most typically in arms or legs. It usually occurs when they lymph vessels or lymph nodes are blocked or removed
Primary Lymphedema
rare and congenital caused by poor development of lymph vessels.
ex: milroys disease
Secondary Lymphedema
caused by damage to lymph vessels or nodes.
may result from surgery, radiation, neoplasm, irradiation, trauma (scar tissue can block flow)
Edema
swelling caused by an increase in fluid in the interstitial, intra-articular or intra-celluar space
Types edema
Local
Systemic
Lymphedema
Local edema
edema is confined to an area (ligament sprain)
Systemic edema
occurs throughout the body (congestive heart failure)
Contraindicated
Precautions for massage
Hematoma Non-union fractures Herniated Disks Debilitated patients Malignancies Conditions w/collagen weakening
Friction Massage Intended purpose
- to mobilize adherent tissue/reduce scar tissue
- reduce/mobilize trigger points
- increase local circulation
- decrease pain
Types of Friction Massage
- cross-fiber friction
- circular friction
- linear/parallel friction
- cryiax friction
Cross-fiber friction
deep friction applied perpendicular to the direction of the fibers
Parallel Friction
deep friction applied in the same direction as the fibers
Circular Friction
repeated circular motion, distal to proximal considered
Cyriax Friction
deep transverse friction for pain and inflammation relief in musculoskeletal conditions
Mechanical Effects of Cyriax
- mobilization of damaged tissue over a small area
- elongation of tissue fibers
Physiological Effects of Cyriax
localized hyperemia
Histological Effects of Cyriax
- prevents or slows scar formation
- stimulates collagen orientation along lines of stress
Neurological Effects of Cyriax
pain inhibition via stimulation of mechanoreceptors
Indications for Cyriax
- promote healing of connective and contractile tissue
- to retain or regain mobility
- pain modulation
Contraindications for Cyriax
- acute inflammation
- hematoma
- conditions that increase bleeding
- hemophilia
- pt. on anit-coagulants
- pt. on steroids
- debilitated/open skin
DTFM
deep transverse friction massage (cyriax)
Body Positioning for DTFM
- Muscles: supported in a position of relaxation or reduced muscle tone
- Tendons: position of tension
- Ligaments: taunt, as far as the ROM allows
Cyriax finger position
middle finger on top of pointer finger
Effects of Cyriax Friction
- Traumatic Hyeremia
- Movement of Structures, prevents or disrupts adhesions
- Stimulates mechanoreceptors, causing analgesia
Cyriax Friction Key Points
- friction is applied to an exact location
- no movement between the fingers and skin
- friction is applied in transverse direction
- friction must have adequate amplitude to move completely over the structure
- friction must be applied at a depth sufficient to reach the target structure
Side Lying Manuvers
- Jostling
- Hacking
- Slapping
- Cupping
- Gorilla punch
Trigger Point Background
- pioneered by Janet Travell MD
- 1st to recognize and define myofascial pain syndrome and trigger points
Definition of Trigger Points
focus of hyper irritability in a tissue that when compressed is locally tender an if sufficiently hypersensitive gives rise to referred pain
Techniques to treat trigger points
- ice & stretch
- spray & stretch
- massage
- digital compression
- PNF
- TPPR
- muscle stripping
what does a biopsied trigger point look like?
- large, rounded
- darkly stained muscle fibers
- significant increase in diameter of muscle fibers
Characteristics of Trigger Points
- cosistent referred pain pattern upon compression
- local twitch response elicited by palpation
- possible restricted ROM
- muscle weakness w/no atrophy
- possible autonomic phenomena
Two Types of Trigger Points
- Active Trigger Point
2. Latent Trigger Point
Active Trigger Points
- always tender
- produce referred pain
- muscle may be weak
- limited ROM
- w/palpation there is a localized twitch
Latent Trigger Points
- painful only when palpated
Indications for Intermittent Compression
Edema
Contraindications for Intermittent Compression
- Thrombophlebitis (could dislodge clot)
- Cellulitis (Could spread the infection) (bloodbourne)
- Severe congestive heart failure
Treatment time for Intermittent Compression
- 10 minutes to 4 hours
- 1 to 2 times per day
Duty cycle for Intermittent Compression
45 sec on/15 sec off to 3 mins on/1 min off
Pressure for Intermittent Compression
- should never exceed 90-120 mmHg (systolic pressure)
- Arm: approx 50mmHg
- Leg: approx 60-70 mmHg
Types of Swelling
Joint Swelling
Interstitial tissue swelling
Cell swelling
Joint Swelling
caused by presence of blood and joint fluid in joint as a result of tearing
- appearance/feel of a water balloon
Intersitial tissue swelling
caused by increase of osmotic pressure in tissues
- attracts water
- appearance of silly putty
- pitting edema
Cell swelling
cells near death and unable to control the cell membrane can attract water and swell
Pitting Edema causes
- congestive heart failure (heart is too stretched out)
- venous insufficiency
- kidney failure
- malnutrition
Factors that can cause Edema
- HBP
- low blood plasma (alcoholism)
- Lymphatic blockage (post mastectomy) (swelling, no drainage)
- increased capillary porosity (burns)
- increased tissue oncotic pressure (cell destruction w/protein release)
Lymphedema
edema caused by obstruction of the lymph channels
Treatment of Edema
- elevation
- muscular contraction
- compression
- elastic compression
- massage
- intermittent compression
Treatment Protocol for DTFM
- initial treatment 5 to 6 minutes
- first couple of minutes pt may feel mild to moderate tenderness
- pain should subsides gradually increase the pressure
- increased by 3 minutes each session, 12 to 15 minute max
- wait 48 hours between treatment sessions
