Massage theory:

Massage and its various techniques have both direct effects on the physical tissues and responses of the nervous system known as reflexive effects. The following are some general principles to guide your massage experience.

General to Specific to General: always begin with lighter pressure with more generalized strokes to warm the tissue and make it more receptive to change. Then begin to use more specific techniques on knots and TPs. Finish with more generalized lighter pressure: increase relaxation and improve muscle release. Yum it up before and after to prevent guarding!

Guarding: the bodies contractile response to pain or threat. May be completely subconscious but is counterproductive to muscle releasing. Be mindful of pressure even if subject has a high tolerance for pain. Pain does not equal gain.

Muscles form in many layers. The deeper the layer you want to affect, the slower you go. Moving slowly prevents Guarding by providing time for the subjects body to adjust and reducing the pain in a tender area.

Massage Strokes and Techniques

Strokes:

Effleurage: long, smooth, gliding strokes, spread the lotion

Effects: relaxation, warms skin for deeper penetration, spreads lotion

Petrissage: Kneading, scooping, lifting muscle tissue away from flesh

Friction: short rapid motions to generate heat, realign scar tissue, reduce adhesions

-Crossfiber: apply friction perpendicular to muscle fibers or visible scar(best for scar tissue)

-Lateral: apply friction in the direction of the muscle fibers

-Circular: apply friction in circular motion(best for adhesions)

-Multidirectional: apply friction in the shape of an asterisk over affected area(best for pain reduction)

Direct Pressure/Compression: General or specific, compress for prolonged periods of time for release; triggers reflexive relaxation effects and increases fresh blood flow to affected area

C-bow: use thumb or finger to bend taut muscle band into the shape of a c, hold until muscle softens and releases(can take upwards of 30s, be patient)

S-bow: use two thumbs or fingers to bend taught muscle into the shapr of an s, hold pressure until muscle softens and releases

Techniques

MFR(Myofascial Release): using no lotion, apply broad pressure at the origin of a muscle/group.

-Slowly sink deeply into the muscle adding a small wiggle to establish traction. Maintaining pressure begin to slowly move down the length of the muscle feeling for the layers to release and soften under your hands

-At any “sticky” points where movement is halted, add a wiggle until muscle allows movement again

-Continue to end of muscle; if done correctly, the skin will be flushed red and the muscle will be noticeably softer

-Can be repeated multiple times

-A mild burning sensation for the subject is normal and a good indicator that the fascia has been stretched and treated

Pin and Stretch(P/S):Bring muscle to contracted/shortened position

-Compress or pinch muscle, Passively(you move the subject for them) or actively(the subject moves) lengthen muscle while holding the compression

Treatment For Quick Pain Relief/ ROM Increase

Trigger Point Therapy:Trigger points are hyperirritable, tiny nodules of blood and lymph that form in bands of taut muscles that can restrict entire muscles and refer pain to other parts of the body(sometimes pain in one location is caused by a trigger point in a completely separate part of the body)

-Can feel like peas, tapioca, or grains of sand

-Trigger points can form anywhere along a muscle, however, every TP present will be under control of the central trigger point, located, as expected, in the center of the muscle belly. While TPs closer to attachments will be highly sensitive, you will not obtain the same potency or longevity of results if the central TP is not addressed

-Trigger points hunt in packs–where you find one, you will often find others, once the central point has been cleared, feel around and resolve any other points that did not dissipate after clearing the central point

-Trigger points that refer pains are often the primary point relating to the disfunction

-93% of undiagnosed chronic pain is attributed to trigger points

Treatment: 3 main methods, all begin with the following steps:

-Locate taut band of muscle

-Locate nodule within, confer with subject about pain level and referral to ascertain correct spot

-Easy:Warm entire muscle using various techniques(s-curve, c-curve, sifting, swedish techniques, pnf, mfr, p/s)

Continue to holding on specific point for up to a minute at a time until pain recedes to 2 or below on subjects pain scale

-Medium:Hold pressure on nodule(do not exceed 6 on subjects pain scale)have subject take deep breaths, directing breath into the pressure of the touch until pain reduces to 2 or below on pain scale or you feel the point evaporate

-Hard:Hold pressure on point and have subject move affected body part through full active range of motion until point dissipates and referred pain is gone

* Always perform a few strokes of pettrisage or effleurage after clearing an area of trigger points to relax and recover the body after treatment

*Trigger points should be worked for no more than a minute at a time on any single point but can be treated up to ten times per day

*The release of significant or multiple trigger points may cause nausea or mild ill feelings as the toxins release and disperse into the body, especially if the subject is new to trigger point therapy. Be mindful of releasing too many per session. Encourage hydration and consumption of electrolytes following treatment.

Proprioceptive Neuromuscular Facilitation(PNF) aka Muscle Energy Techniques:

In laymens terms, PNF is resisting the action of a subject muscle(the agonist) or the opposing action of the reciprocal muscle(the antagonist) to release dysfunctional/hypertonic muscle

-One of the most efficient techniques for: increasing ROMreleasing tight/restricted muscles penetrating deeply into a muscle with less effort and pain revealing the presence of trigger points

Treatment: Agonist Contract/Relax

-Locate restricted or dysfunctional muscle via palpation or ROM testing

-Bring muscle to its lengthened/ most extended position until you feel the end feel

-Apply resistance and have subject press into you for a count of 6-10 seconds the relax, end feel should increase

-Follow the relaxation with mild pressure to new end feel and repeat until desired ROM is achieved

-Hold at achieved ROM and have subject take 2-3 deep breaths(10-30 seconds) this will inform the brain to the body’s new range of motion and acclimate it to the changes

-If the muscle does not release or range of motion does not increase check for trigger points

Reciprocal Inhibition(Antagonist-Agonist)

-Locate restricted or dysfunctional muscle via palpation or ROM testing

-Locate the antagonistic muscle

Ex. Biceps create flexion so the antagonistic would be triceps which create extension Apply resistance and have subject press into you for a count of 6-10 seconds the relax

-Reassess original target muscle*Antagonist-agonist operates on the theory that antagonistic muscles cannot fire at the same time, therefore, by firing the antagonistic muscle the agonist will be forced to release to allow the motion.

Sustained Contract Relax

-Locate restricted or dysfunctional muscle via palpation or ROM testing

-Bring muscle to its lengthened/ most extended position until you feel the end feel

-Apply low, consistent resistance and ask the subject to create a full action against resistance, then relax

-All of these PNF techniques are options for releasing hypertonic muscles and increasing range of motion. If one doesn’t work, check for trigger points then try the others.