Therapeutic Sports MassageTherapeutic Sports Massage

Jennifer Doherty-Restrepo, ATC, LATEntry-Level Athletic Training Education Program

PET 4995: Therapeutic Modalities

Physiologic Effects of MassagePhysiologic Effects of Massage

Mechanical stimulation of tissues by rhythmically applied pressure and stretching

Effects of massage may be either ___________, or ___________

Effects differ depending on method utilized, pressure exerted, and duration of massage

Mechanical stimulation of tissues by rhythmically applied pressure and stretching

Effects of massage may be either ___________, or ___________

Effects differ depending on method utilized, pressure exerted, and duration of massage

Physiologic Effects of MassagePhysiologic Effects of Massage

___________ Effects sensory and motor nerves locally Elicits some central nervous system

response (ie: sedation) ___________

Makes mechanical or histological changes in myofascial structures through direct force applied superficially

___________ Effects sensory and motor nerves locally Elicits some central nervous system

response (ie: sedation) ___________

Makes mechanical or histological changes in myofascial structures through direct force applied superficially

Reflexive EffectsReflexive Effects

Attempts to exert effects through ______ and superficial connective tissues

Contact stimulates _________ receptors Reflex mechanism is believed to be an

autonomic nervous system phenomenon The reflex stimulus causes

Sedation, Relieves tension, and Increases blood flow

Attempts to exert effects through ______ and superficial connective tissues

Contact stimulates _________ receptors Reflex mechanism is believed to be an

autonomic nervous system phenomenon The reflex stimulus causes

Sedation, Relieves tension, and Increases blood flow

Reflexive Effects cont.Reflexive Effects cont.

Effects on Pain Modulates pain through Gate Control & -

Endorphins theories Effects on Circulation

Increases blood and lymphatic flow Effects on Metabolism

Does not alter general metabolism Increases fresh blood and oxygen to area Assists in removal of lactic acid

Effects on Pain Modulates pain through Gate Control & -

Endorphins theories Effects on Circulation

Increases blood and lymphatic flow Effects on Metabolism

Does not alter general metabolism Increases fresh blood and oxygen to area Assists in removal of lactic acid

Mechanical EffectsMechanical Effects

Techniques which stretch a muscle, elongate fascia, or mobilize soft tissue adhesions/restrictions

Always accompanied by some reflex effects As mechanical stimulus becomes more effective,

reflex stimulus becomes less effective Directed at deeper tissues, such as

adhesions or restrictions in muscle, tendons, and fascia.

Techniques which stretch a muscle, elongate fascia, or mobilize soft tissue adhesions/restrictions

Always accompanied by some reflex effects As mechanical stimulus becomes more effective,

reflex stimulus becomes less effective Directed at deeper tissues, such as

adhesions or restrictions in muscle, tendons, and fascia.

Mechanical EffectsMechanical Effects

Effects on Muscle Mechanical stretching of intramuscular

connective tissue to relieve pain and discomfort associated with myofascial trigger points

Increases blood flow to skeletal muscle Slows muscle atrophy following injury Increases range of motion Does not increase strength or muscle

tone

Effects on Muscle Mechanical stretching of intramuscular

connective tissue to relieve pain and discomfort associated with myofascial trigger points

Increases blood flow to skeletal muscle Slows muscle atrophy following injury Increases range of motion Does not increase strength or muscle

tone

Mechanical Effects cont.Mechanical Effects cont.

Effects on Skin Increases skin temperature Increases sweating Decreases skin resistance to galvanic

current Mechanically loosens adhesions and

softens scar tissue Stretches and breaks down fibrous scar

tissue Breaks down adhesions between skin and

subcutaneous tissue

Effects on Skin Increases skin temperature Increases sweating Decreases skin resistance to galvanic

current Mechanically loosens adhesions and

softens scar tissue Stretches and breaks down fibrous scar

tissue Breaks down adhesions between skin and

subcutaneous tissue

Psychologic Effects of MassagePsychologic Effects of Massage

Psychologic effects of massage can be as beneficial as physiologic effects

” ___________" modality where patients feel as if someone is helping them

Psychologic effects of massage can be as beneficial as physiologic effects

” ___________" modality where patients feel as if someone is helping them

Treatment Considerations and GuidelinesTreatment Considerations and Guidelines

Knowledge of ___________ is essential

Understanding of existing pathology Thorough knowledge of massage

principles

Knowledge of ___________ is essential

Understanding of existing pathology Thorough knowledge of massage

principles

Positioning of ClinicianPositioning of Clinician

Prevent ___________ Permit free movement of

arms, hands, and body Evenly distribute weight by

shifting from one foot to the other

Fit your hands to the contour of area being treated

Hands should be clean, warm, dry, and soft

Prevent ___________ Permit free movement of

arms, hands, and body Evenly distribute weight by

shifting from one foot to the other

Fit your hands to the contour of area being treated

Hands should be clean, warm, dry, and soft

Treatment TechniquesTreatment Techniques

Pressure regulation Determined by the type and amount of

tissue present and patient's condition Rhythm

Must be steady and even Strokes should overlap

Duration Depends on the pathology, size of the

area being treated, speed of motion, age, size, and condition

Pressure regulation Determined by the type and amount of

tissue present and patient's condition Rhythm

Must be steady and even Strokes should overlap

Duration Depends on the pathology, size of the

area being treated, speed of motion, age, size, and condition

Treatment TechniquesTreatment Techniques

Swelling Begin proximally to facilitate lymphatic

flow “___________“ Body part may be elevated if necessary

Direction of forces should parallel muscle fibers

Make sure patient is warm and in a comfortable, relaxed position Massage should never be ___________

Swelling Begin proximally to facilitate lymphatic

flow “___________“ Body part may be elevated if necessary

Direction of forces should parallel muscle fibers

Make sure patient is warm and in a comfortable, relaxed position Massage should never be ___________

Treatment TechniquesTreatment Techniques

Sufficient lubricant should be used Begin with superficial stroking to spread

lubricant Begin and end with ___________

Pressure should be in line with venous flow followed by a return stroke

Sufficient lubricant should be used Begin with superficial stroking to spread

lubricant Begin and end with ___________

Pressure should be in line with venous flow followed by a return stroke

Equipment Set UpEquipment Set Up

Table Linens and pillows Lubricant

Should be absorbed slightly by skin but does not make it slippery

Combination of one part beeswax to three parts coconut oil

Other types of lubricants that may be used are olive oil, mineral oil, cocoa butter, hydrolanolin, analgesic creams, alcohol, and powder

Table Linens and pillows Lubricant

Should be absorbed slightly by skin but does not make it slippery

Combination of one part beeswax to three parts coconut oil

Other types of lubricants that may be used are olive oil, mineral oil, cocoa butter, hydrolanolin, analgesic creams, alcohol, and powder

Preparation of PatientPreparation of Patient

Patient should be in a relaxed, comfortable position

Part involved in treatment must be adequately supported

Prone, supine, seated Patient should

appropriately draped

Patient should be in a relaxed, comfortable position

Part involved in treatment must be adequately supported

Prone, supine, seated Patient should

appropriately draped

Hoffa MassageHoffa Massage

Classical massage technique which uses a variety of superficial strokes Effleurage Petrissage Tapotment Vibration

Classical massage technique which uses a variety of superficial strokes Effleurage Petrissage Tapotment Vibration

Effleurage Effleurage

Any stroke that glides over skin without attempting to move deep muscles

Hands are molded to treatment area

Apply constant pressure moving toward _______ Lighter pressure applied

on the return stroke

Any stroke that glides over skin without attempting to move deep muscles

Hands are molded to treatment area

Apply constant pressure moving toward _______ Lighter pressure applied

on the return stroke

Every massage begins and ends with effleurage!

Effleurage cont.Effleurage cont.

Moderate pressure according to patient and condition Deep stroking is a form of effleurage, except it

is given with more pressure to produce a mechanical effect

Increases venous and lymphatic return Increases circulation to skin surface

Moderate pressure according to patient and condition Deep stroking is a form of effleurage, except it

is given with more pressure to produce a mechanical effect

Increases venous and lymphatic return Increases circulation to skin surface

PetrissagePetrissage

Kneading manipulations

Muscles are gently lifted, rolled, and released

Pressure is applied intermittently

Hands may remain stationary or move along length of muscle or limb

Kneading manipulations

Muscles are gently lifted, rolled, and released

Pressure is applied intermittently

Hands may remain stationary or move along length of muscle or limb

Petrissage cont.Petrissage cont.

Increases venous and lymphatic return

Removes metabolic waste products

Breaks up adhesions between skin and underlying tissue

Increases venous and lymphatic return

Removes metabolic waste products

Breaks up adhesions between skin and underlying tissue

TapotmentTapotment

Percussion massage Series of rapid, brisk blows

Increases circulation and blood flow Stimulates peripheral nerve endings

Percussion massage Series of rapid, brisk blows

Increases circulation and blood flow Stimulates peripheral nerve endings

Tapotment cont.Tapotment cont.

Hacking Hacking

Tapotment cont.Tapotment cont.

Hacking Slapping

Hacking Slapping

Tapotment cont.Tapotment cont.

Hacking Slapping Beating

Hacking Slapping Beating

Tapotment cont.Tapotment cont.

Hacking Slapping Beating Tapping

Hacking Slapping Beating Tapping

Tapotment cont.Tapotment cont.

Hacking Slapping Beating Tapping Clapping or

cupping

Hacking Slapping Beating Tapping Clapping or

cupping

VibrationVibration

Shaking massage Tremulous movement

made by hand or fingers placed firmly against a body part Rhythmical trembling

movement will come from ___________

Hands should remain in contact with the body part

Shaking massage Tremulous movement

made by hand or fingers placed firmly against a body part Rhythmical trembling

movement will come from ___________

Hands should remain in contact with the body part

Transverse Friction MassageTransverse Friction Massage Technique used for treating chronic tendon

inflammation or connective tissue adhesions Stimulates ___________ ___________ to progress

healing process Apply small circular motions penetrating to deeper

tissues Apply strong pressure in ___________ direction to

fibers for 7 to 10 minutes every other day

Technique used for treating chronic tendon inflammation or connective tissue adhesions

Stimulates ___________ ___________ to progress healing process

Apply small circular motions penetrating to deeper tissues

Apply strong pressure in ___________ direction to fibers for 7 to 10 minutes every other day

Acupresure and Myofascial Trigger Point MassageAcupresure and Myofascial Trigger Point Massage

Acupressure points are based on ancient Chinese art of acupuncture

Myofascial trigger points found in… Muscle and tendon myofascia Ligaments and capsules surrounding

joints Periosteum

Acupressure points and myofascial trigger points are similar

Acupressure points are based on ancient Chinese art of acupuncture

Myofascial trigger points found in… Muscle and tendon myofascia Ligaments and capsules surrounding

joints Periosteum

Acupressure points and myofascial trigger points are similar

Acupresure and Myofascial Trigger Point MassageAcupresure and Myofascial Trigger Point Massage

Pain results due to inflammatory response following direct trauma or overuse

Pain usually referred to areas which follow a specific pattern

Stimulation of these points has been demonstrated to result in pain relief

Pain results due to inflammatory response following direct trauma or overuse

Pain usually referred to areas which follow a specific pattern

Stimulation of these points has been demonstrated to result in pain relief

Acupressure Massage TechniquesAcupressure Massage Techniques

Locate points from chart Use fingers, or elbow, to

apply small friction-like circular motions

Amount of pressure applied should be intense and painful

Patient reports a dulling or numbing effect

Treatment times range from 1-5 minutes at several points

Locate points from chart Use fingers, or elbow, to

apply small friction-like circular motions

Amount of pressure applied should be intense and painful

Patient reports a dulling or numbing effect

Treatment times range from 1-5 minutes at several points

Myofascial ReleaseMyofascial Release

Also called soft tissue mobilization Techniques used to relieve soft tissue from

abnormal grip of tight fascia Myofascial restrictions are unpredictable

and may occur in many different planes and directions

Based on localizing restriction and moving into the direction of the restriction

Myofascial manipulation is subjective and relies heavily on the experience of the clinician

Also called soft tissue mobilization Techniques used to relieve soft tissue from

abnormal grip of tight fascia Myofascial restrictions are unpredictable

and may occur in many different planes and directions

Based on localizing restriction and moving into the direction of the restriction

Myofascial manipulation is subjective and relies heavily on the experience of the clinician

Myofascial Release TechniqueMyofascial Release Technique

Protecting the clinician’s hands Use fist or elbow if necessary

Use limited lubricant Avoid slipping of hands on the skin

Positoning of the patient is critical Maximize effects of treatment

Protecting the clinician’s hands Use fist or elbow if necessary

Use limited lubricant Avoid slipping of hands on the skin

Positoning of the patient is critical Maximize effects of treatment

Indications For MassageIndications For Massage

Increase coordination Decrease pain Decrease

neuromuscular excitibility

Stimulate circulation Facilitate healing Restore joint mobility Remove lactic acid

Increase coordination Decrease pain Decrease

neuromuscular excitibility

Stimulate circulation Facilitate healing Restore joint mobility Remove lactic acid

Alleviate muscle cramps Increase blood flow Increase venous return Retard muscle atrophy Increase range of motion Edema Myofascial trigger points Stretching scar tissue

Alleviate muscle cramps Increase blood flow Increase venous return Retard muscle atrophy Increase range of motion Edema Myofascial trigger points Stretching scar tissue

Indications For MassageIndications For Massage

Adhesions Muscle spasm Myositis Bursitis Fibrositis Tendinitis

Adhesions Muscle spasm Myositis Bursitis Fibrositis Tendinitis

Revascularization Raynaud's disease Intermittent

claudication Dysmenorrhea Headaches Migraines

Revascularization Raynaud's disease Intermittent

claudication Dysmenorrhea Headaches Migraines

Contraindications For MassageContraindications For Massage

Arteriosclerosis Thrombosis Embolism Severe varicose

veins Acute phlebitis Cellulitis

Arteriosclerosis Thrombosis Embolism Severe varicose

veins Acute phlebitis Cellulitis

Synovitis Abscesses Skin infections Cancers Acute inflammatory

conditions

Synovitis Abscesses Skin infections Cancers Acute inflammatory

conditions