Introduction to Massage Techniques
PTA 101 Introduction to Clinical Practice 1
The following information is used for instructional purposes for students enrolled in the Physical Therapist Assistant Program at Lane Community College. It is not intended for commercial use or distribution or commercial purposes. It is not intended to serve as medical advice or treatment.
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Manual techniques facilitate relaxation, correct movement dysfunction, and directly connect the patient/client with their health care provider. Therapeutic touch through massage can be used to reduce signs and symptoms of soft tissue injury, demonstrate empathy, and build trust. In this lesson, we will focus on professionalism and safety with introductory manual techniques and introduce massage approaches for pain reduction and soft tissue repair.
1. Describe indications, precautions, contraindications, primary effects, and anticipated outcomes of manual therapy, massage, joint mobilization, soft tissue techniques, myofascial trigger point
2. Describe the correct application of manual techniques used to mobilize soft tissue
3. Classify descriptions of massage stroke techniques
4. Describe the purpose and types of lubricant used in massage
5. Identify rationale and methods of facilitating positioning for soft tissue mobilization (bolsters, pillows, towels, etc)
6. Compare and contrast recreational vs. therapeutic massage
In physical therapy, there is often confusion about the differences between massage and soft tissue mobilization.
The American Medical Association Current Procedural Terminology (CPT) defines therapeutic procedures as "A manner of effecting change through the application of clinical skills and/or services that attempt to improve function." (AMA, 2007). Examples of therapeutic procedures include therapeutic exercise to develop strength and endurance, range of motion and flexibility; neuromuscular re-education of movement, balance and coordination; gait training; and manual therapy techniques (e.g., manual traction).
Manual therapy techniques (e.g., mobilization/manipulation, manual lymphatic drainage, manual traction), one or more regions
"mobilization/manipulation" includes soft tissue and joint structures
soft tissue mobilization (includes all tissue that is not bone/joint) are manual techniques to improve function and decrease pain by improving intertissue mobility (muscle, skin, fascia, tendons and ligaments).
massage therapy: applying pressure with the hands to affect primarily the musculoskeletal, circulatory-lymphatic system and nervous system to treat discomfort or pain
Massage therapy is defined by the AMA as a "passive modality". Passive modalities are physical agents and techniques which primarily effect acute pain and swelling or the pain associated with the exacerbation/reactivation of an acute condition.
Therefore, physical therapists consider tissue healing rates and how the patient/clients pain is contributing to loss of function when selecting the most appropriate manual technique(s) for the individual case.
I have put together a series of brief lectures on manual techniques.
Notes page for lecture on manual techniques
Christina's lecture on manual techniques - part one
Christina's lecture on manual techniques - part two
As you watched the linked videos, notice the body mechanics, application of anatomy knowledge, and whether or not the treatment is considered active or passive. See if you can anticipate the impairments and the functional improvements that may result from integrating these manual techniques into a treatment session.
These examples are introducing the concept of joint mobilization, which will be covered more in depth in your Applied Kinesiology course
Recreational : use of a variety of manual techniques to promote relaxation and general wellness, relieves stress; no identifiable health problem.
Therapeutic: in addition to recreational outcomes, mobilization of structures to prevent deformity, decrease pain and swelling, and promote functional independence in person who has a heath problem.
In physical therapy, we use our hands to help patients and client progress toward treatment goals. Manual contact is an essential part of our practice and the burden is on the practitioner to maintain professionalism.
Massage is rendered through direct skin contact. Patients and clients are in some state of undress during massage treatments. The treatment environment should be warm and quiet and there should be adequate blankets, pillows and sheets to allow for self-draping and additional draping as needed during the treatment.
A PTA implements skills in hygiene (short, trimmed nails, jewelry removed, clean hands and body, minimize hand perspiration), communication (informed consent/choice, open and neutral body language), positioning (self and patient/client), privacy and draping prior to initiating massage.
If the PTA can maintain themselves in a relaxed, comfortable state, their hands become their "eyes" into the soft tissues. With practice, PTAs can distinguish normal from restricted tissue mobility, therefore optimizing treatment outcome by working with the most appropriate timing, direction, and pressure during massage and mobilization.
Manual work can be tiring. A PTA should modify their positions and techniques to minimize overuse. Correct techniques includes total body movements which are well coordinated with the hands. Hand flexibility, stretching, using other body parts (palms, thumb, ulnar border of wrist), proper body mechanics, and good upper body strength and endurance will help protect the PTA from overuse injury.
Lubricants decrease friction between the hands and the patient's skin. The result is increased patient comfort and smoother movements. Skin can develop sensitivities over time to lotions, oils and creams, so some providers may need to be selective or discontinue use of lubricants due to allergic reactions
|
Type |
Example |
Advantages |
Disadvantages |
|
Powder |
Unscented baby powder, talc |
Allows for deep tissue manipulation with minimal hand slipping Facilitates movement over skin, but allows hand and skin to move together to reach deeper tissues |
Messy If it gets on the floor of treatment area, the floor may be slippery May become a lung irritant to therapist/patient if inhaled |
|
Creams |
Moisturizing cream (i.e., Lubriderm, Lanolin) |
Allows hands to glide comfortably over skin |
Can be absorbed by the skin, changing the amount of lubrication during the session |
|
Oils |
High quality natural (plant-based), such as almond, olive, sesame |
Small amounts can be distributed evenly Preferred for dry and low nutrition areas (e.g., scar) |
Messy, can stain patient's clothing and items used for draping Does not allow for enough friction for targeting deeper structures; difficult to grip soft tissue |
Direction, pressure, rate, rhythm, duration and frequency will depend on patient and the anticipated treatment outcome. For example, procedures for relaxation to decrease pain are markedly different than procedures to increase mobility of scar tissue. Specific procedures are described in the Moodle webpage, "Positioning and Soft Tissue Mobilization Images
|
Direction |
Dependent on the targeted outcome of the treatment Centripetal: toward the heart - in the direction of venous and lymphatic flow; generally associated with strokes which increase/effect circulation Centrifugal: away from the heart - in the direction of arterial flow; non-specific in an anatomical region
|
|
Pressure |
Varies from extremely light to heavy; varies from constant to progressive (light to heavy) Largely dependent on feedback from patient and patient's age, sensory system, and soft tissue status |
|
Rate and Rhythm |
Relaxation: slow, gentle and rhythmic; may include overlapping circular motions Stimulating: rapid, clapping |
|
Duration and Frequency |
Varies with treatment plan: body region (10-15 min) compared to whole body (45+ min); deeper cross friction techniques are generally of shorter duration due to tissue effects and increased risk for tissue injury; duration depends on the size of treatment area and extent of injury. Integrated with other functional PT interventions (e.g., exercises, therapeutic activities, postural awareness training) with documentation to support incremental benefit in progressing toward meeting short and long term goals. |
|
Manipulation (Stroke Type) |
Variations |
|
Stroking - Effleurage |
Stroking
|
|
Pressure - Petrisage |
Kneading Picking up Wringing Skin rolling |
|
Percussion - Tapotement |
Hacking Clapping Beating Pounding |
|
Vibration and shaking |
|
|
Deep frictions |
Transverse Circular
|
Precautions, contraindications, tissue effects, and massage techniques are further outlined in your Moodle resources