Outcome-Based Massage

Question 1

Definition of Massage

Answer 1

A systematic treatment approach in which therapists provide massage interventions with the goal of achieving specified outcomes that are tailored to address each client’s unique needs, presenting issues, and preferences

Question 2

What does massage include?

Answer 2

Clinical decision making, evidence based practice, and therapeutic relationship

Question 3

Features of OBM

Answer 3

identification of patient’s impairments or goals, defining treatment outcomes, planning and appropriate delivery of intervention, selection of technique, technique modification/progression based on re-assessment and patient response

Question 4

Therapeutic effects of Massage (local or throughout body)

Answer 4

1. Mechanical
2. Reflex
3. Physiologic
4. Psychologic
5. Psychoneuroimmuniologic
6. Energetic

Question 5

Mechanical Effects

Answer 5

Due to physical movement of tissues: compression, tension(stretch), shearing, bending, twisting

Question 6

Outcome Examples of Mechanical Effects

Answer 6

increased lymphatic return, mobilization of bronchial secretions

Question 7

Reflex Effects

Answer 7

functional change as mediated by the nervous system

Question 8

Outcome examples of Reflex Effects

Answer 8

sedation, arousal, facilitation of muscle contraction

Question 9

Physiological Effects

Answer 9

any change in biochemical body processes

Question 10

Outcome examples of physiological effects

Answer 10

remodeling of connective tissue, reduced muscle spasm

Question 11

Psychological Effects

Answer 11

effects that impact the mind, emotion, or behavior

Question 12

Outcome examples of psychological effects

Answer 12

improvement in social interaction, improved physical self- image

Question 13

Psychoneuroimmunologic Effects

Answer 13

changes in psychologic state impacts hormonal and/ or immunologic function, “feelings” like relaxation can represent complex system of responses throughout the body

Question 14

Outcome examples of psychoneuroimmunologic effects

Answer 14

decreased anxiety, increased cortisol levels, improved T-cell functioning

Question 15

Energetic Effects

Answer 15

direct effects on biomagnetic field, possible secondary effects on body structures and functions

Question 16

Outcome examples of energetic effects

Answer 16

improved biomagnetic field pattern, improved energy flow

Question 17

International Classification of Functioning, Disability and Health

Answer 17

Model represents individual at 3 levels ( body structures and functions, activity, participation)
Patient’s clinical situation affects all 3 levels.
Personal factors and environment factors also affect all three levels.

Question 18

MUSCULOSKELETAL impairments amenable to treatment with massage

Answer 18

adhesions, abnormal CT, postural malalignment, trigger points

Question 19

PSYCHONEUROIMMUNOLOGIC impairments amenable to treatment with massage

Answer 19

stress (perceived relation, decrease levels of cortisol, epinephrine and norephinephrine)

Question 20

MULTISYSTEM impairments amenable to treatment with massage

Answer 20

Pain (reduced pain by effecting target issue ex: trigger point)

Question 21

Activity and Participation/ Functional Outcomes

Answer 21

mobility, walking, self care, decreased need of adaptive equipment, improved safety, increased ability to participate in recreation and leisure activities

Question 22

Interpersonal and Ethical Issues for Massage

Answer 22

therapeutic relationship, client-centered care, therapeutic contact, ethical conduct in therapeutic relationship, obtaining informed consent, communicate clearly, ensure privacy and confidentiality, recognize and manage the emotional responses to massage

Question 23

Contraindications

Answer 23

large open wound, gross edema with comprised skin, marked varicosities, hyperesthesia, hemophilia, hemorrhage, metastatic cancers, sepsis, shock, severely compromised circulatory system, such as: associated with congestive heart failure, kidney failure, advanced respiratory failure, etc.

Question 24

Precautions(not exhaustive list)

Answer 24

local conditions: allergies to lubricants, acute inflammatory condition, pitting edema, fracture, kidney infection

general conditions: asthma, cancer, chronic system disease, emphysema, epilepsy, osteoporosis

Question 25

Therapeutic Massage

Answer 25

the use of manual techniques designed to promote: stress relief and relaxation, mobilize structures, relieve pain and swelling, prevent deformity, promote functional independence * in an individual who has a specific health problem

Question 26

Massage Components

Answer 26

1. therapist 2. patient 3. treatment area 4. lubricants/ media 5. duration and posture 6 rate and rhythm

Question 27

Media

Answer 27

Lubricants (oil, lotion, cream, powders) Soap and Hot water Alcohol Selection (desired effect, area being treated, condition of skin, personal preferences)

Question 28

Application of Media

Answer 28

apply to both hands ( warm the lubricant), warm your hand with warm water if cold, CHECK FOR ALLERGIES, apply only as needed, remove excess when treatment is completed

Question 29

Media: Things to Avoid

Answer 29

analgesic balms, lotions that absorb or evaporate too quickly, too much media

Question 30

Draping

Answer 30

expose only area treated, remove/loosen tight clothing, cover clothing adjacent to treated area, cover hair with towel

Question 31

Necessary to develop the therapeutic relationship

Answer 31

build trust, understand sensations, create healthy closure

Question 32

Observation

Answer 32

observe patient closely and modify treatment as necessary, understand signs of tension

Question 33

Essential for Effective Massage

Answer 33

Patient must be supported and muscles relaxed Patient must be positioned to use gravity to assist circulation toward heart Strokes must be applied and directed appropriately

Question 34

Five Basic Strokes

Answer 34

Effleurage, Petrissage, Friction, Tapotement, Vibration

Question 35

Initial Stroking

Answer 35

Application of media over the entire area to be massaged Rate: slow and rhythmical Effects: mechanical influence on tissues, reflexive influence on sensory system

Question 36

Effleurage: Superficial

Answer 36

Mechanical: moving blood and lymph in superficial vessels toward the heart, increased tissue mobility= promotes ROM

Question 37

Petrissage (Kneading)

Answer 37

deep kneading and squeezing of subcutaneous fascia and muscles: pressure is variable- superficial to deep, preceded and followed by effleurage Mechanical effect applied to: reduce edema and congestion, mobilize tissues

Question 38

Therapeutic Uses

Answer 38

promote deep and superficial circulation, mobilize muscle fibers,skin, and subcutaneous tissues, assist in resolving edema, to relieve pain and muscle fatigue, promote relaxation

Question 39

Petrissage: Contraindications

Answer 39

acute status of muscle tissue or acutely inflamed joints, skin diseases,severely compromised circulatory system, damaged vessels, malignancy in or near area treated, bacterial infections in or near treatment area

Question 40

Tapotement (Percussion)

Answer 40

bricks blows applied in a rapid, alternating pace

Question 41

Types of Tapotement

Answer 41

Hacking, cupping, beating, tapping, pincement, and slapping

Question 42

Tapotement Therapeutic Uses

Answer 42

chest physical therapy (cystic fibrosis), stimulation effect, relief of neuralgia & desensitization (post amputation)

Question 43

Vibration

Answer 43

trembling/ shaking movement loosen secretions in lungs (mechanical) stimulation of tissues (reflex)

Question 44

Tapotement and Vibration Contraindications

Answer 44

potential to damage underlying tissues, in thoracic area with cardiac conditions, risk of pulmonary embolism, severe hypertension, flaccidity, spasticity, new scar tissue, acute conditions, malignancy or tuberculosis

Question 45

Friction

Answer 45

Purpose: massage deep into joint space, loosen scar tissue, break adhesions Skin and superficial tissues are moved over underlying structures

Question 46

Transverse friction

Answer 46

applied at right angles to long axis fibers, application at exact location necessary, muscles relaxed, tendons taut, general pressure applied in one direction only, may be uncomfortable for patient Therapist: precaution to prevent joint stress

Question 47

Transverse friction duration

Answer 47

5-20 minutes, may not be repeated daily but on a 2-3 times per week as tolerated

Question 48

Friction Effects

Answer 48

``` increased vasodilation (reflexive) mobilization of structures (mechanical) painful response ```

Question 49

Friction Contraindications

Answer 49

acute muscle tears or acutely inflamed joints, skin diseases, damage or diseased blood vessels, malignancy or tuberculosis, increased risk of spreading bacterial infections