MOBILE MASSAGE

Techniques


Groups of Sports Massage Methods

1. Effleurage
2. Petrissage
3. Vibrations
4. Tapotement
5. Dermal lifting
6. Compression
7. Friction
8. Stretching - active and passive

Effleurage

The current term for effleurage is "gliding stroke". Effluerage originates from the French verb meaning "to skim" and "to touch lightly on". The most superficial applications of this stroke do this, but the full spectrum of effleurage is determined by pressure, drag, speed, direction and rhythm, making this technique one of the most versatile.

The distinguishing characteristic of effleurage is that it is applied horizontally in relation to tissues. Increasing pressure adds a compressive force and drag to the stroke. Superficial applications that stay with the skin and subcutaneous layer, tend to have a more reflexive effect, while deeper strokes have a more mechanical effect.

Strokes that use moderate pressure from the fingers and toes toward the heart following the muscle fibre directions are excellent for mechanical and reflexive stimulation of blood flow, particularly venous return and lymphatics. Light to moderate pressure, with short, repetitive effleurage stroking following the patterns for the lymph vessels is the basis for manual lymph drainage.

During effleurage, moderate pressure extends through the subcutaneous layer to reach muscle tissue, but not so deep as to compress the tissue against the underlying bony structure. Moderate to heavy pressure that puts sufficient drag on the tissue will mechanically affect the connective tissue and the proprioceptors (spindle cells and Golgi tendon organs) found in the muscle. Heavy pressure produces a distinctive compressive force of the soft tissue against the bone.

The more superficial the stroke the more reflexive the effect. Slow, superficial strokes are very soothing while fast, superficial strokes are stimulating. If a deeper stroke pressure with a slower rate of application is used, the effect will be more mechanical.

The long broad method of this stroke is ideal for spreading the lubricant on the skin surface. This method can be used repetitively while gradually increasing the depth of pressure. This is one of the preferred methods to warm or prepare the tissue for more specific bodywork. Because of the nature of this technique, the flow pattern of the massage can progress smoothly from one body area to another. It is a good method to use when evaluating for hard and soft tissue, hot and cold areas. Effluerage is the preferred method for abdominal massage. 

Technical description

The skin is stroked with pressure towards the heart. Applied with hands, hand or forearm. Pressure is kept constant and the contact area is relatively broad.

General effects (physiological effects)

  1. Warms skin, subcutaneous and muscle tissue (mechanical effect of pushing, friction from rubbing and vacuum from pressure)
  2. Improves venous and lymphatic flow
  3. Increases permeability of cell membrane (cells expand, warmer membrane becomes thinner, easier to take in nutrients and expel waste)
  4. Speeds removal of waste and supply of nutrients

Effleurage techniques

1. bilateral

2. butterfly

3. reverse butterfly

4. cam and spindle

5. reverse cam

6. figure 8

7. flat hand

8. forearm glide

9. half moon

10. heel and thumb

11. opposing glide

12. pisiform

13. rake

14. reverse rake

15. rotary

16. "V"

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Petrissage

Petrissage comes from the French verb "petir" meaning "to knead" requires that soft tissue be lifted, rolled and squeezed by the massage therapist. Pertrissage functions vertically.

The main purpose of this manipulation is to lift tissue. Once lifted, the hand is used to squeeze the tissue as it rolls out of the hand while the other hand prepares to lift additional tissue and repeat the process.

Petrissage is very good for decreasing muscle tone. The lifting, rolling and squeezing action affects the spindle cell proprioceptors in the muscle belly. By squeezing the belly of the muscle (thus squeezing the spindle cells) the muscle feels less stretched. When lifting, the tendons are stretched, thus increasing the tension in both the tendons and the Golgi tendon receptors, which have a protective function. The result of this sensory input is to reflexively relax the muscle to keep it from harm.

Petrissage is good for mechanically softening the superficial fascia. The fascia forms a major part of each muscle. Petrissage has the mechanical effect of softening and creating space around the actual muscle fibres and making the tendons more pliable as well. The tension on the tendon as it is pulled deforms the connective tissue and mechanically warms it.

Sometimes a clients tissue will not lift. This may be due to excessive edema, a heavy fat layer, scarring that extends into the deeper body layers and thickened areas of connective tissue. Petrissage under these conditions may be uncomfortable for the client and it may be best to switch to effleurage and compression which may soften tissue enough so that pertrissage can be used more effectively.

Petrissage is a rhythmic technique. The speed of manipulation is limited. If the tissue is lifted quickly or squeezed too fast it can be uncomfortable for the client. The speed and frequency of the application is determined by how much tissue can be lifted and how long it takes for that tissue to be rolled and squeezed through the hand.

Technical description

Two hands move in inwardly moving circles which intersect. The points of intersection are pinched during this movement between forefinger and thumb.

Effects

  1. Warms skin, dermal layers and muscle.
  2. Reduction of sub-cutaneus lipids.
  3. Stretches some muscles.
  4. Increases cell permeability.

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Vibrations

Shaking is a massage method that is effective in relaxing muscle groups or an entire limb. Shaking manipulations confuse the positional proprioceptors so the muscles relax. The sensory input is too unorganised for the integrating systems of the brain to interpret, and going limp is the natural response in such situations. Shaking warms and prepares the body for deeper bodywork and works with joints in a nonspecific manner.

Rocking is soothing and rhythmic form of shaking that has been used since the beginning of time to calm people down. Rocking works through the vestibular system of the inner ear and feeds sensory input directly into the cerebellum. It is probable that other reflex mechanisms are affected as well. For rocking to be most effective, the body must move so that the fluid in the semi-circular canals of the inner ear are affected, initiating parasympathetic mechanisms.

Shaking begins with lift and pull components. There is a lift of a limb and then a fairly abrupt downward or side to side movement that ends suddenly . Even the most subtle shaking movements deliberately move the joint or muscle tissue to affect the receptors.

The larger the muscle or joint, the more intense is the method. If movements are done with all the slack out of the tissue the focus of the shake is very small and is extremely effective. The more focused and purposeful the approach, the smaller the focus of the shaking will be. You should always stay within the limits of both range of motion of a joint and "give" of the tissues. The goal is to see how small the shake can be and still have a physiologic effect.

Shaking should be used when the muscles seem extremely tight. This technique is reflexive in its effect, but there may be a small mechanical effect on the connective tissue as well owing to the lifting and pulling component of the methods.

Rocking is rhythmic and should be applied with a deliberate full body movement. Rocking involves the up-and-down and side-to-side movement of shaking, but there is no snap at the end of the movement. The action moves the body as far as it will go, then allows it to return to the original position. After two or three rocks, the clients rhythm can be sensed. At this point, the massage therapist works with the rhythm, either by attempting to extend gently the limits of movement, or by slowing down the rhythm. Nothing is abrupt; there is an even ebb and flow to the methods. Rocking is one of the most effective relaxation techniques of the massage therapist.

With a tense and anxious client, begin with slightly more abrupt and bigger shaking manipulations. As the muscles begin to relax, switch to rocking methods. Rocking is reflexive and chemical in its effects, both at the whole body and individual joint levels.

Shaking focuses more on the soft tissue while rocking focuses on the joint receptors. Both methods work on all the tissues through the stimulation of the nervous system, primarily the proprioceptors of the muscles and joints.

Technical description

 The rhythmic rocking, swaying, shaking or rolling of the body or limb.

Effects

Deeply relaxing, mesmeric, putting a person into a state where they are vulnerable to suggestion

eg before psychologist

Vibrations can also mobilise joints

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Tapotement

The term tapotement comes from the French verb "tapoter", which means "to rap, drum or pat". Tapotement techniques require that the hands or parts of the hand administer springy blows to the body as a fast rate. The blows are directed downward to create a rhythmic compression of the tissue. Tapotement can be light or heavy, the difference being determined by whether the force of the blows penetrates only to the superficial tissue of the skin and subcutaneous layers, or deeper into the muscles, tendons and visceral (organ) structures.

Tapotement is a stimulating manipulation that operates through the response of the nerves. The effects of the manipulations are reflexive except for the mechanical results of tapotement in loosening and moving mucus in the chest (children with cystic fibrosis). The strongest effect of tapotement is due to the response of the tendon reflexes. A quick blow to the tendon stretches it. In response, protective muscle contraction results.

Tapotement is very effective when used at motor points. The repetitive stimulation causes the nerve to fire repeatedly, stimulating the nerve tract. Tapotement focused primarily on the skin affects the superficial blood vessels of the skin, initially causing them to contract. Heavy tapotement or prolonged lighter application will dilate the vessels due to the release of histamine, a vasodilator. While prolonged tapotement seems to increase blood flow, surface tapotement enhances the effect of cold application used in hydrotherapy.

When applied to joints, tapotement affects the joint kinesthetic receptors responsible for determining the position and movement of the body. The quick blows confuse the system similar to the effect of joint focused rocking and shaking, but the body muscles tense instead of relaxing. This method is useful for stimulating weak muscles. The force used must move the joint but should not be strong enough to damage the joint. Because of its intense stimulating quality to the nervous system, tapotement initiates or enhances sympathetic activity of the autonomic nervous system.

In tapotement, two hands are usually used alternately. When tapping a motor point, one or two fingers can be used alone. The forearm muscles contract and relax in rapid succession to move the elbow joint into flexion and then allow it to quickly release. This action travels down to the relaxed wrist, extending it; the wrist thus moves back and forth to provide the action of the tapotement. It is controlled flailing of the arms as the wrists snap back and forth. The wrist must always stay relaxed.

Technical description

Percussion techniques that include slapping, cupping, hacking with direct and deflected alternate blows.

Dynamic, reactionary, noisy. Can be applied with one or two hands.

General effects

  1. Fast erythema of skin
  2. Stimulates fight or flight
  3. Stimulates aggressiveness
  4. Stimulates peripheral nerves

Techniques

  1. Hacking
  2. Cupping
  3. Slapping
  4. Flicking
  5. Pinching

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Dermal Lifting

In this technique only the skin is lifted from the underlying muscle layer. Dermal lifting only lifts the skin and has a warming and softening effect on the superficial fascia. It causes a reflexive stimulation to the spinal nerves and is an excellent assessment method. Areas of "stuck" skin often suggest underlying problems.

Dermal lifting is one of the very few massage methods that is safe to use directly over the spine. Because only the skin is assessed and the direction of pull to the skin is up and off of the underlying bones, there is no chance of injury to the spine, as there is when any type of downward pressure is used.

Other variations incorporate a kneading, twisting or wringing component once the tissue is lifted. Changes in depth of pressure and drag will determine whether the manipulation is perceived by the client as superficial or deep. By the nature of manipulation, the pressure and pull peak when the tissue is lifted as far as it can be, can become less at the beginning and the end of the manipulation.

Sometimes a clients tissue will not lift. This may be due to excessive edema, a heavy fat layer, scarring that extends into the deeper body layers and thickened areas of connective tissue. Dermal lifting under these conditions may be uncomfortable for the client and it may be best to switch to effleurage and compression which may soften tissue enough so that dermal lifting can be used more effectively.  

Technical description

The lifting of the skin/and dermal layers away from the muscle and skeletal structures.

General effects

  1. Reduces adhesions between skin and underlying soft tissues
  2. Reduction of lipids
  3. Erythema of skin

Techniques

  1. Spade
  2. Skin rolling
  3. Skin shaking

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Compression

Compression uses a lift-press method and moves down into the tissues with varying depths of pressure. The manipulation of compression usually penetrates the subcutaneous layer and much of the effect results from pressing tissue against the underlying bone, causing it to spread and be squeezed from two sides. As with most methods, the deeper the pressure the greater the mechanical effect.

Compression disconnects from the body with each lift and then reconnects with each press in a piston like fashion. Pressing rhythmically into connective tissue will soften it mechanically. Pressing tissue against the underlying hard bone will spread the tissue mechanically, enhancing the softening effect of the connective tissue component of the muscle.

Compression in the belly of the muscle will spread the spindle cells, causing the muscle to think it is stretching. To protect the muscle from over-stretching, the spindle cell will signal for the muscle to contract. The lift-press application will stimulate the muscle and nerve tissue. These two effects combine to make compression a good method to tone muscles and stimulate the nervous system.

Compression proceeds downward, and the depth is determined by what is to be accomplished, where it is to be applied, and how broad or specific the contact area of the body. Compression can be done over clothing, the disadvantage being that you can not feel so well. In this case have good communication and ask the person.

Compression can be done with the point of the thumb, stabilized fingers, palm and heel of the hand, fist, knuckles, elbow and very occasionally the knee and heel of the foot. Because of the diagonal patter of the muscles, the therapist should stay perpendicular or at a 90 degree angle to the bone, with actual compression between 45 and 90 degrees to the body, beyond these angles the stroke may slip.

Technical description

Direct, usually static, pressure applied by thumb, fingers, fist, heel (of hand) and elbow into muscle tissue.

General effects

  1. Reduces muscle hypertone
  2. Reduces adhesed tissue
  3. Decompression of tissue

Techniques

  1. THUMB
  2. FINGER
  3. HEEL (OF HAND)
  4. FIST
  5. ELBOW

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Friction

Friction consists of small deep movements performed on a local area. No lubricant is used and the skin should move with the fingers, a friction burn will result if the fingers are allowed to slide over the skin. Friction breaks up adhesions in connective tissue, mainly over tendons, ligaments and scars. This method cannot be used over acute injury or fresh scars, but once the acute phase has passed, it may prevent adhesions from developing.

The movement of friction is usually transverse to the fibre direction, it is generally performed from 30 seconds to ten minutes. This friction causes a small controlled inflammatory response. The chemicals released during the inflammation cause the re-organisation of connective tissue.

Friction is a mechanical approach best applied to areas of connective tissue such as the musculotendinous junction. Microtrauma from repetitive movement and overstretching are common in this area.

When using friction the main focus is to move tissue under the skin. No lubricant is used since there must be no slide of the tissues. The movement is produced by applying a specific and moderate to deep compression and moving the upper tissue back and forth across the grain or fibre of the undertissue for transverse or cross-fibre friction. This method is painful and so must work to within the clients comfort zone.

The area frictioned may be tender for up to 48 hours after treatment and should be similar to mild post-exercise soreness. Friction is the controlled application of a small inflammatory response, causing heat and redness from the release of histamine and increased circulation. A small amount of puffiness occurs as more water binds with the connective tissue area but is should not bruise.

Technical description

Cross fibre rubbing over a muscle tendon or ligament. The stroke is usually applied in the same direction. Friction can be performed by the thumbs, fingers and knuckles.

(Sometimes called deep transverse friction, can do on nerves)

General effect

  1. Trauma of soft tissue
  2. Reduction of scar tissue
  3. Trauma to blood vessels

Techniques

  1. FINGER
  2. THUMB
  3. KNUCKLE

Friction can be done on ligaments, muscles and tendons. It is a deep technique and you should not friction on the skin, the skin should be moving in unison and the muscle relaxed.

(knee and ankle ligaments may be stretched)

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Stretching

Stretching is a mechanical method of pulling tissue to reduce tensile stress which affects tendons, ligaments and areas of connective tissue.

The techniques of passive and active movement and proprioceptive neuromuscular facilitation work with the neuromuscular reflex system to relax and lengthen muscles. Stretching has both a reflexive and mechanical effect and is more focused on the connective tissue.

Stretching involves moving jointed areas within the physiologic limits of range of motion of the client. Active stretching means that the client moves the joint by active contraction of the muscle groups. Active assisted means that both the client and therapist move the area. Passive movement is when the clients muscles stay relaxed and the therapist moves the joint with no assistance from the client.

Stretching should always be done within the comfortable limits of the range of movement of the client. Anatomical barriers are determined by the shape and fit of the bones at the joint. Physiological barriers are caused by the limits of the range of motion imposed by nerve and sensory function, this displays itself as stiffness or pain. When moving a joint it is important to stay within these barriers and to gently and slowly encourage the joint to increase the range of motion.

Range of motion is a good assessment tool and should be used before and after any type of joint work because it provides information about the limits of range of motion and the improvement after the work is completed.

PASSIVE STRETCH

Technical description

The elongation of a muscle and its connective tissues by an external agent with no help from the individual

General effects

1) Increase muscle length

2) Increase joint range of movement

3) Decrease muscle tension

4) Increase elastic strength

ACTIVE STRETCH

Technical description

Facilitating a stretch effect on muscle by various active proprioceptive actions of the muscle and its antagonists

General effects

1) Increase muscle length

2) Increase joint range of movement

3) Decrease muscle tension

4) Increase elastic strength

Definitions

Flexibility - associated with muscles (ability of muscles to stretch)

Mobility - associated with joints (you do not stretch a joint, after immobilisation, ligaments may be stiff and need mobilising


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