What is Clinical Therapeutic Massage about?
Therapeutic massage is very individual. The treatment will begin with a proper assessment. The assessment consists of a patient history form, guided conversation about the patient´s problem, and signs and symptoms the patient is experiencing. Than if necessary, functional and orthopedic tests will be conducted to rule out systemic problems and to clarify the tissue affected.
Therapeutic massage itself consists of different techniques, chosen according to the patient’s health and goals they want to achieve. I am able to prepare a management plan with short and long term goals to achieve a maximal therapeutic effect.
Techniques Performed in my Treatments:
- Myofascial and fascial release
- Fascia is dense irregular connective tissue which surrounds and connects every muscle, even the tiniest myofibril, and every single organ of the body forming continuity throughout the body (Schliep, 2002). Myofascial release techniques are applied using a sustained gentle but firm pressure into the restriction. Myofascial release techniques decrease cross-linking of fascia. This will ease the pressure exerted on pain sensitive structures and increase mobility of the fascia. (Barnes, 2006).
- Trigger point therapy
- Trigger point (TrP) is a hyper-irritable spot within a taut band of muscle or within a muscle´s fascia. TrP’s are painful on compression and give rise to characteristic referred pain, referred tenderness, motor dysfunction, or autonomic phenomena (Travell, J.G., Simons, D.G., Simons, L.S.,1999). There are a variety of techniques to treat myofascial TrPs which include skin rolling, repetitive muscle stripping, and ischemic compressions. Post treatment application of heat, a pain free stretch, and active range of motion to reset the muscle are part of trigger point therapy (Rattray, F., Ludwig, L., 2010).
- Swedish massage and petrissage
- Swedish massage techniques make up the groundwork used by a massage therapist. Swedish massage consists of efflurage, stroking, vibrations, tapotement and petrissage such as kneading, muscle squeezing, muscle stripping, wringing, picking up, and skin rolling. These techniques are usually used with oil or lotion. The effect of the massage depends on pressure, direction, rhythm, rate, and duration (Rattray, F., Ludwig, L., 2010).
- Joint mobilizations
- Direct or indirect mobilization techniques applied to a joint. Joint mobilizations are most commonly associated with restoring range of motion. Joint mobilizations are indicated for such things as: post-immobilization due to fractures, ligamentous sprains, tendonitis, or adhesive capsulitis. Massage therapists use all three grades of sustained glides and traction mobilizations. Oscilations have 5 grades. Massage therapist’s scope include grade I and II which are non-corrective manuípulations and grade III and IV – which are corrective manipulations that stretch a joint capsule. Grade V is also called chiropractic thrust and is only in a chiropractor´s scope of practice (Dixon, M., 2006).
- Muscle energy techniques
- Muscle energy technique is a manual medicine treatment procedure that involves the voluntary contraction of a patient muscles in a precisely controlled direction, at varying levels of intensity, against a distinctly executed counterforce applied by the therapist (P. E. Greeman, 1996).
- Musculo-tendinous attachment release
- Musculo-tendinous attachment release is defined as stretching and softening of muscles and their attachment sites by the use of direct mechanical pressure to produce increased tissue length, increased tissue mobility, vascular flushing of local tissue, and neural desensitization of the attachment fibers. The purpose is to reduce effects of muscular hyper tonus and irritability of attachment fibers due to dysfunctional adaptation of neural feedback mechanism. This technique is indicated when there is restriction of a motion due to adhered attachment sites and chronic muscular hyper tonus without significant orthopedic pathology present (Ingram, R., 2013).
- Golgi tendon organ release
- Golgi tendon organs (GTOs) are propripceptive nerve organs or minute sensory organs located in tendons near the musculo-tendinous junction. GTOs are able to slow alpha motor neurons firing and thus cause relaxation of the muscle (Rattray, F., Ludwig, L., 2010). GTO release technique applies moderate to deep pressure on GTOs in the opposite direction from the muscle belly. Passive or active range of motion is used with the technique for approximation or separation of the tissue. The active range of motion is used for resetting of the muscle.
- Proprioceptive neuromuscular facilitation
- Proprioceptive neuromuscular facilitation (PNF) techniques are used for stretching. This technique integrates active muscular contraction and stretching maneuvers to facilitate or inhibit muscle activation. There are several types of PNF stretching procedures: contract-relax, agonist contract and hold-relax with agonist contraction. (Kinser, C., Colby, L.A., 2007)
- Pin & Stretch
- Pin & Stretch techniques can be adapted or applied to any myofascial structure. The therapist places the muscle in a shortened position, pins the specific myofascial fibres and passively lengthens the muscle while pinning force is still applied. This helps to release adhesions in the muscle.
- Frictions and Cross fiber frictions
- Cross-fibre frictions (XFF) is a technique described by James Cyriax, MD. The technique is specifically intended to disrupt and break down existing and forming adhesions in muscles, tendons and ligaments using compression and motion. This technique is used in subacute or chronic stages of healing (Rattray, F., Ludwig, L., 2010). XFF application can be painful. The technique creates local inflammation so it is followed by an ice application. Passive stretch or active range of motion are applied to promote laying down of collagen in functional lines of tension.
- Therapeutic exercise
- A lot of soft tissue problems can not be solved with massage therapy alone. Therapeutic exercises given for home care is often necessary. It is important to stretch the shortened muscles and strengthen the weak structures in order to acquire a balanced posture. Core strength and endurance is also very important for proper posture and health. (Kinser, C., Colby, L.A., 2007)
- Hydrotherapy uses water in its solid, liquid, or gaseous form for its therapeutic effects. Application of heat or cold can enhance effects of massage therapy. It is also an important part of home care. Basically the acute injuries are treated with ice. Subacute phase of healing respond to contrasts of heat and cold, which increase local circulation and, chronic problems respond well with heat. (Sinclair, M., 2007)
- Positional release
- Positional release technique is accomplished by placing the involved tissue in an ideal position for comfort. The purpose is to reduce the irritability of the tender point and to normalize the tissue associated with the dysfunction. The ideal position is determined subjectively by the patient´s perception of tenderness and objectively by the reduction in palpable tone of the tender point. There are two major phases of release phenomenon: Neuromuscular phase which lasts approximately 90seconds to 3 minutes and myofascial phase which may last up to 20 minutes.
- Rood´s facilitatory and inhibitory techniques
- These techniques were developed by Margaret Rood, an American physical therapist. Different techniques target different receptors in different tissues – tendons, muscles, skin, and joints. Facilitatory techniques are stimulating and inhibitory techniques are sedating. These techniques are useful for a number of different situations, some being in patients with multiple sclerosis either to stimulate muscles or skin receptors or to decrease spasticity.
- Lymph drainage techniques
- Light, repetitive techniques are used to pump the lymphatic fluid through the superficial lymphatic capillaries. Therapist´s hands are soft and relaxed and no lubrication is needed. Lymph drainage techniques are used especially to decrease edema.
- Reflexology is zone therapy. It works by massaging hands and feet to boost other parts of the body. Hands and feet contain more than 7800 nerve endings which correspond with all organs in the body. It constitutes a virtual map of our body. During reflexology the massage therapist’s thumbs stimulate reflex points on the sole of the foot. The effect of reflexology is reinforcement of the life energy in the weakened point of the organism, regeneration, and detoxification.
- Chinese pressure massage
- Chinese pressure massage is one part of traditional Chinese medicine. The principles originate in Taoism. 12 couple and 8 special lines, so called meridians, are arranged into energetic circles. Each meridian contains acupuncture points. Massage is performed without oil and the main method is pressure point massage and massage of the meridians.
- Barnes, J.F. (2006, December). The John F. Barnes Myofascial Release Approach: The tree-part series explores the history of myofascial release, myofascial unwinding and myofascial rebounding. Massage magazine. Retrieved from http://myofascialreleasebrisbane.com.au/pdf/JFBApproach_part1_MFRBNE.pdf
- Dixon, M. (2006). Joint Play the right way for the axial skeleton. Vancouver: Arthrokinetic Publishing
- Greeman, P.E. (1996). Principles of manual medicine, second edition
- Ingram, R. (2013). WCCMT Manual Skills 2 Course notes. New Westminster
- Kinser, C., Colby, L.A. (2007). Therapeutic Exercise Foundations and Techniques. Fifth Edition. Philadelphia: F. A. Dawis Company
- Rattray, F., Ludwig, L. (2010). Clinical massage therapy: Understanding, assessing and treating over 70 conditions. Toronto: Talus Incorporated
- Schleip, R. (2002). Fascial plasticity – a new neurobiological explanation: Part 1. Journal of Bodywork and movement Therapies (2003), 7(1), 11-19. doi:10.1016/S1360-8592(02)00067-0
- Sinclair, M. (2007). Modern Hydrotherapy for the Massage Therapist. Lippnincott Williams & Wilkins
- Travell, J.G., Simons, D.G., Simons, L.S. (1999). Myofascial pain and dysfunction: The trigger point manual, Volume 1. Upper Half of Body, second edition. Philadelphia: Williams & Wilkins