Massage Prac 3 = Theory Exam 1

What is Remedial Massage?

When massage is practiced at a professional, rather than a technical level, it is influenced by a number of
intellectual activities.
It should be:
Directed by initial assessment of the patient,
Modified to suit needs of the individual
Adapted in light of individuals response

Stress Strain Curve for Soft Tissues

Normal
Physiologic
Range

Injuries:
Grade 1 Grade 2
(microscopic failure)

Grade 3
(macroscopic failure)

Treatment according to Grade Injury *

1st Aid management

Grade I & II

Grade III

Soft tissue massage

Joint mobilisation
Electrotherapeutic modalities

Surgery repair,
reconstruction or
protective bracing

Muscle strengthening; Proprioceptive training;

Functional training
Alternative Grades for Tendinopathy
GRADE
I
II
III
IV

Symptoms
Pain only after activity
Pain at start of activity that disappears
Pain returns after activity
Pain not sufficient to restrict activity
Pain at start of activity that persists during & after activity
Restriction of activity
Pain during everyday activities
Pain progressing or worsening

Grades of Acute Muscle Strain *

Grade I a few fibers have been stretched or torn
-

point tenderness
pain on active ROM
full ROM possible (with pain)

Grade II a number of fibers have been torn

-

active contraction is painful

some swelling
moderate loss of function
some instability due to partial tearing of the tissue

Grade III up to complete rupture of muscle or musculotendinous junction.

-

severe pain (that may diminish due to nerve damage)

large amount of swelling
complete loss of function
complete instability

Characteristics of Fascia *
Thixotropic:
Changes chemically from a sol or fluid substance to a solid or gel like substance.- Consistency varies from:
- fluid & watery dense & thick,
- from elastic & resilient stiff & resistant
- Changes with time & in response to injury, stress & disease, becoming less fluid (Sol) & more
solid(gel) as we age

Viscoelastic:
Resists a suddenly applied force (deep pressure applied too quickly)
- Will elongate with a constantly applied force over time (constant pressure applied slowly i.e.
myofascial stroke)

Hydrophilic:
Likes water.
- During myofascial soft tissue manipulation, the aqueous (water) portion of the ground substance of
the fascia becomes absorbed into & hydrates collagenous portion of the fascia

Piezoelectric:
Ability to generate an electric potential in response to applied mechanical stress
- Absorbed water serves as the conductive medium for the movement of electrons during mechanical
tissue deformation

Facial Creep:
Will shorten over time due to constantly applied force of gravity unless otherwise lengthened by an
intervening force
- When fascia becomes tight & stuck its unable to return to its loose & fluid state without intervention
= forms scar tissue

Tendonitis & Tendinosis *

Tendonitis or Tendonitis: Means "inflammation of the tendon," inflammation is rarely the cause
of tendon pain.
Tendinosis: Refers to tiny tears in the tissue in & around the tendon caused by overuse.

(MFR) Myofascial Release - No Oil

Direct Myofascial Release:
-

Take fascia towards restriction/adhesion engages soft tissue barrier tissue then taken beyond
barrier
Used to increase excursion & flexibility of fascia

Indirect Myofascial Release:

-

Low pressure applied to traction restricted fascia to heat & blood circulation in restricted fascia
Intention is to maximize potential for changes in fascia using its characteristics of thixotrophy,
viscoelasticity, piezoelectric effects allows tissue to unwind itself
i.e. dysfunctional tissues guided along path of least resistance until free movement is achieved

(DCTM) Deep Connective Tissue Massage No oil

In order to stretch CT, therapist needs to apply a downward pressure, sink into 1st level that gives
resistance, & then drop angle of contact in order to create a wave in front of point of contact.
The wave is maintained in front as stroke is performed
o Gain informed consent & explain P scale
o Use body supports (e.g. thoracic roll) to straighten body part
o Use dry warm up techniques e.g. compressions
o DO NOT USE OIL drag rather than slip because we need to move superficial layers of skin & fascia.
work slowly rather than sliding quickly
o
o
o
o
o
o
o

Incorporate clients breathing when working on trunk

Work within clients P range & get client feedback
Apply slow deliberate strokes to small areas i.e. stroke only goes a short distance
Maintain correct posture to use body weight to lessen pressure on your joints
Use different body parts bent middle phalanges (not knuckles), fist, forearm, elbow
After applying technique loosen & stretch structure &/or take joint through full ROM
Instruct client to drink lots of water

(TP) Trigger Point

A hyperirritable spot within a taught band of mm/fascia
- exhibiting a predictable pain referral pattern shortening of affected mm
- A TP is an area of both metabolism & circulation (But not neural activity)
Method:

Does this P refer? Or is it only local?

Is this like your P?
Use P scale up to 7, apply pressure slowly & maintain until P reduces (20/30 sec)
Has the P changed? what is it now?

Active TP: P with characteristic referral pattern at rest without stimulation

-

Prevents full lengthening of mm

P spreading or radiating
Cause mm weakness

Latent TP: No P unless palpitated, may restrict movement & cause mm weakness
-

Client presenting with mm restrictions /weakness only aware of P when pressure is applied directly
over point

Associated TP: Develop due to compensatory overload

-

Shortened ROM or referred phenomena due to TP activity in another mm i.e., agonist/antagonist or

synergist mm

Satellite TP: Lie on a referral zone of another TP & become activated

Secondary TP: Lie in synergist or antagonist mm & become activated

(DTF) Deep Transverse Friction - No lubrication

Non-gliding oil-less stroke involving pressure & movement directed across grain of soft tissue fibers of CT

Method:
Position soft tissue properly:

Relax mm bellies to broaden fibres, allowing greater penetration to tease apart mm fibres
Ligaments need to elongated in both directions (DTF in both directions) & take joint as far as
possible in one direction & then opposite direction.
Tendons should have minimal tensile tension in most accessible position
Tendons with a sheath should be taut to form immobile base against which to rub tendon
sheath roll/move the sheath over the tendon
# NOTE USE ICE PACK WHEN COMPLETING THIS TECHNIQUE

(STR) Soft Tissue Release small amount of lubrication

Also referred to as: movement assisted massage; shifting:
-

lock & key,

pin & stretch

anchor & stretch

Dependent on using lengthening or broadening

Basic concept of STR is to apply pressure (lengthening or broadening) to a specific area with passive
or active movement of the tissue under pressure

General Procedure

1. static pressure passive movement

2 & 3. longitudinal pressure passive movement
A. movement in direction of muscle lengthening
B. movement in opposite direction to muscle lengthening
4. static pressure active movement
5 & 6. longitudinal pressure active movement
A & B as above
1-6: muscle starts short and lengthens (eccentric contraction)
7. broadening pressure active movement
7: muscle starts long and shortens (concentric contraction)

Temperature Therapy
Huntings Response *
An automatic response whereby body ensures vasoconstriction (& therefore lack of blood flow) does not
continue for any length of time
Ice should be applied for max of 10-15 min at a time to lessen intensity of any autonomic compensatory
reaction (vasodilation of cooled blood vessels) of body to cooling

COLD Indicated; *
-

In acute stages of inflammation reaction

After ROM exercises for rehabilitation
After physical activity

General Principles:
Test area to be cooled with cold skin sensation test
Informed consent: Inform client ice may burn, Check client response often
Check client is comfortable & affected part well supported
Apply while mm is stretched as much as P will allow (better when mm is used again)
Do not ice for longer than 10-15 min
Apply with full explanation including what it will feel like & how long it will take

HEAT Indicated;*
-

To control inflammation reaction in its sub-acute or chronic stages

Encourage tissue healing
Improve ROM before physical activity or rehabilitation

General Principles:
Check client is comfortable & affected part well supported
Test area to be warmed with hot skin sensation test
Informed consent: Inform client treatment may burn, Check client response often
Warn client of possible side effects i.e. initial itching, burning sensation, & hot sensation
Best effect gained when hot pack applied for 15 -20 min