Soft Tissue Mobilization / Massage Flashcards
STM definition
“a mechanical manipulation of body tissues for the purpose of promoting health and well-being”
Drawbacks
- time consuming! (5-7 min but most tx actually call for 20-30min)
Benefits
- promotes local and systemic relaxation
- increases local blood flow
- breaks down adhesions
- facilitates venous return
AT use of STM
- edema removal (POST acute phase)
- chronic back/neck injuries
- tendonitis and ITB friction syndrome
- chronic muscular injuries (scar tissue)
- athlete should NOT enjoy it
- should always be used in combo with another tx
indications
- pain (POST acute cycle)
- edema
- muscle spasm
- trigger points
- adhesions/scar tissue (transverse cross friction - post tommy john UCL surg)
- anxiety
- decreased ROM
Contraindications
- acute injury / local inflammation
- fever, infections (systemic/skin)
- skin conditions
- burns, open wounds
- pain caused by pressure
- DVT (don’t want to dislodge clot)
- tissue irritability
- malignancies
Effleurage
- most versatile and commonly used
- “stroking”
- used to start and end massage and transition
- enhances venous flow
- deep effleurage provides some stretch to muscle
- progress depth and adapt speed of strokes (start light and go harder to accommodate skin to pressure you will apply)
- maintain contact
- superficial tissue: stimulates sensory nerves
- deep tissue: use palms/knuckles to stimulate deep tissues
- smooth, firm, continuous motion
shingles effleurage
- continuous alternating (between hands) stroking
- strokes overlay each other
- one hand always in contact
- done many times to parallel the spine
Petrissage
- lifting, kneading, wringing, and rolling of tissues
- targets muscle
- progress depth and alter speed of tx
- separates muscle fiber, fascia, and scar tissue
Benefits: - “milks” muscle of waste products
- assists with venous return
- relaxes muscle
petrissage: basic 2 handed kneading
lifting and squeezing and then releasing the soft tissue with hands
alternating in rhythmical motion
petrissage: skin rolling
- tissue are picked up between thumb and first 2 fingers and gently pulled away from deeper tissues
- thumbs may push forward causing rolling affect of tissue
Tapotement
- percussion: gentle tapping or pounding
- hand strikes tissue at rapid rate (loose and relaxed hands)
- stimulates muscular and systemic relaxation
- desensitization of irritated nerve endings
TYPES:
- hacking/chopping (most common)
- pincement (plucking)
- cupping (thumb and fingers slightly flexed and palmar surface contracted)
- rapping (similar to hacking but uses lightly closed and loosely held fists)
Deep transverse Friction
- friction, cross-friction, DTF, deep massage
- DEVELOPED EMPIRICALLY BY JAMES CYRIAX
- indicated for muscle, ligament, and tendon injury
Proposed mechanism of action of DTF
- pain relief via gate control theory / endogenous opiate release
- collagen re-orientation during maturation phase
- prevention of adhesions
- separated muscle fibers
- ruptures existing adhesions –> increasing ROM
- increases local blood perfusion
- increases circulation
- dilates blood vessels = lowers BP
- warming area meanwhile = friction is key (perpendicular to structure)
Friction
- to break up adhesions by way of increasing space between collagen fibers
- fingers and skin move together
- directly over lesion
2 TYPES: transverse and friction
Transverse Friction Massage
- strokes perpendicular to tissue fibers
- thumbs/fingertips stroke in opposite directions
Circular Friction Massage
circular friction:
- to break up scar tissue
- to soften a healing scar
- can use circular motion with thumbs, elbow, commercial device
DTF Treatment Protocol
Cyriax:
- 6-12 sessions
- alternate days
- 20’
Starkey:
- 1/day
- 5’ PRN (as long as needed)
- if targeting muscle –> want it relaxed
- for a tendosynovitis –> want it on stretch
- will be PAINFUL
Edema Reduction Massage
PREP
- elevate
- lube
- postion distal to extremity
STROKE SEQUENCE
- begin proximal to edematous area to facilitate lymphatic flow proximally (too painful to start distal and push all fluid proximal)
- long, slow, deep strokes towards torso
- move more distal after every 4th or 5th stroke
TERMINATION
- remove medium
- if appropriate: AROM ex, compression wrap
- encourage pt to drink water to assist in flushing metabolic waste
- inspect area for cuts/abrasions
Massage for event settings
use energizing techniques:
- light effleurage
- short tapotement
- broad area petrissage
- stretch with breath
Massage in Therapeutic Settings
recovery, relaxation use calming techniques: - firm effleurage - specific petrissage - sustained tapotement (like hot tub jet) - passive ROM - myofascial/energetic holds
