MASSAGE

PREPARED BY
SINDHURA.K.PRASANTH
 Massage is the scientific mode of curing
certain forms of disease by systematic
manipulations - Murrel
 Massage refers to all mechanical
procedures that can cure illness - Hoffa
 Massage signifies a group of procedures,
which are usually done with hand on the
extertnal tissue of the body in a variety of
ways either with a curative, palliative or
hygenic point in view – Graham
 Massage is a healing art
Classification of
techniques
 On the basis of character of technique
 According to the nature of character of
technique classical/manual massage
techniques are classified into following 4
basic groups.
1. Stroking manipulation: superficial stroking,
effleurage
2. Pressure manipulation: kneading,
petrissage, friction
3. Tapotement/ percussion manipulation
4. Vibratory manipulation
 Stroking manipulations
 The technique of this group consists of linear
movements of relaxed hand along the whole length
of segment known as “strokes”, which usually cover
one aspect of the entire segment of the body at a
time. An even pressure is applied throughout the
strokes, which are repeated in rhythmical way
 Superficial stroking: it is rhythmically linear
movement of hand or a part thereof over the skin in
either direction, i.e. proximal to distal or vice versa
without any pressure
 Effleurage: it is the linear movement of hand over the
external surface of body in the direction of venous
and lymphatic drainage with moderate pressure
 Pressure manipulations:
 In this group of techniques the hand of the therapist
and skin of the patient move together as one and
fairly deep localised pressure is applied to the body
 The technique are directed towards the deeper
tissue
 The aim is to achieve the maximal mechanical
movement of different fibres with application of that
maximum pressure
 Kneading
 Petrissage
 friction
 Kneading: in this group of techniques the tissue are
pressed down on to the underlying firm structure and
intermittent pressure is applied in circular direction,
parallel to the long axis of bone. The applied pressure
increases and decreases in a gradual manner but the
contact of the therapist hand with pt body is never
interrupted
 Digital kneading: pressure is applied with the fingers
(finger kneading) or thumb (thumb kneading)
 Palmar kneading: pressure is applied with the palm
 Reinforced kneading / ironing: the lower hand, placed
over one another are used to apply pressure. The
lower hand which is in contact with the pt’s skin
receives reinforcement from the other hand
 Petrissage: in this category of massage, the tissues are
grasped and lifted away from the underlying structures
and intermittent pressure is applied to the tissue in the
direction that is perpendicular to the long axis of the
bone. Different techniques used are:
 Picking up: tissues are lifted away from underlying
structures, squeezed and then released using one or
both hands
 Wringing: using both the hands tissues are lifted away
from the underlying structures squeezed, twisted and
then released
 Skin rolling: the skin and fascia are lifted up with both
the hands and moved over the subcutaneous tissues by
keeping a roll of lifted tissue continuously ahead of
moving thumb
 friction: in this group of technique the
tissue are subjected to small range of to
and fro movement performed with
constant deep pressure of finger or
thumb
 Circular friction: direction of movement
is circular
 Transverse friction: to and fro movement
is performed across the length of
structure. It is also called cross-fibre
massage
 Vibratory manipulations
 In this group of techniques, the mechanical energy is
transmitted to the body by the vibrations of the distal
part of upper limb, i.e hand and or fingers which are in
constant contact with the subjects skin, using the
body weight and generalized co contraction of upper
limb muscles. This techniques is mainly directed
towards the lung and other hollow cavities
 Vibration: in this technique the fine vibrations are
produced, which tend to produce fine movement of
hand in upwards and downward direction
 Shaking: coarse vibrations are produced which tend to
produce fine movement of hand in sideway direction
 Percussion/ tapotement manipulations
 In this group of techniques a succession of soft,
gentle blows are applied over the body, which
produce a charatcteristic sound. The striking hands
are not in constant contact with the skin and strike
the body part at regular interval. This results in the
application of an intermittent touch and pressure to
the body during these manipulations
 Clapping- cupped palm
 Hacking- ulnar border of 5th, 4th and 3rd digits
 Beating: anterior aspect of the clenched fist
 Tapping: pulp of the fingers
 Pounding: medial aspect of clenched fist
 On the basis of depth of tissue
approached
 Light massage: the force applied during
the manoeuvre are light, so that the effect
of massage is confined to the superficial
tissue only eg. Stroking, tapping etc
 Deep massage techniques: the force
applied during the massage are moderate
to deep so that the effect of massage
reaches to the deeper tissues like muscle:
eg. Friction, kneading etc
 On the basis of region massaged
 General massage: massage applied to the
entire body is usually termed as general
massage. However, massage administered
to a large body segment like the back,
lower limbs etc can also be included in this
category.
 Local massage: when massage is
administered in a particular area of the
body segment it is termed as local
massage. This is used in the treatment of
the local pathological conditions
 On the basis of means of administration of
technique
 Manual massage: the word “manual” refers
to the lying on of hand over the subjects
body. The massage administered with the
hand or other body part of therapist is called
manual massage
 Mechanical massage: when the mechanical
devices based on the principles of massage
administer the mechanical energy to the pt’s
body in order to manipulate soft tissue, it
may be termed as mechanical massage
PHYSIOLOGICAL EFFECTS

1. Effects of massage on the circulatory system :

a. On the venous and lymphatic flow:
 Massage aids in the mechanical emptying of the veins
and lymphatic's. It facilitates the forward movement
of the venous blood and lymph and thereby reduces
the chance of stagnation of blood and lymph in tissue
space
 The flow of venous and lymphatic channels in the
extremities mainly depends on the activity of smooth
muscle present in the walls of vessels
 The contraction of these small muscles in conjunction
with valves present in vessels act as strong pumping
mechanism which keeps tissue tissue space pump
b. On the arterial flow
1. Release of vasodilators
 massage acts as a succession of mild
traumatisation
 It provokes and brings about the
release of histamine and other
substances
 The liberation of histamine plays an
important role in the vasodilation
2. Activation of axon reflex:
 Massage activates the axon reflex,
which produces cutneous vasodilation
 When an area of the skin is firmly
stroked, the sensory nerve endings are
stimulated
 The impulse is carried to the spinal cord
by the peripheral nerve
 The effect is the relaxation of smooth
muscles of arterial wall and vasodilation
3. Decrease of venous congestion:
 If any portion of the vessel is dilated
then the neighboring vessels also
become constricted
 The arterioles become compressed if
the venous congestion is increased
 The congested venous and lymphatic
fluid exerts a compressive force on the
arterioles
 EFFECTS ON BLOOD
 Few studies are available on the effect of
massage on the blood cells
 Wood and Becker quoted increased RBC
count after massage both in health and
anemia
 Schneider and Havens also reported an
increase in RBC and HB count following
abdominal massage. This increases in RBC
and hemoglobin count may increase the
oxygen carrying capacity of blood
 EFFECTS ON EXCHANGE OF METABOLISM
 Massage promotes rapid disposal of waste
products and replenishment of the nutritive
elements
 Massage also increases the movement of liquid
and gases in the body
 The increased arterial blood flow following
massage brings more oxygen and nutritive
elements and also causes more rapid
oxygenation of the blood
 Massage speeds up the lymphatic and venous
flow, which promotes rapid disposal of the waste
products of metabolism
 EFFECTS ON THE SOFT TISSUE
 Massage has significant effect on certain
properties of soft tissues like elasticity,
plasticity and mobility
 The tissues which can be affected by
massage include muscles, sheath,
ligaments, tendons, aponeurosis, joint
capsules and superficial as well as deep
fascia
 The adhesions present between fibers are
broken and maximum mobility between
fibers and adjacent structures is ensured
 MUSCLE STRENGTH
 Massage is capable of increasing
muscular strength
 Strengthening of a muscle can only be
achieved by the active contraction of
muscle
 Massage, at best can prepare the
muscles for contraction by increasing
the circulation and facilitating the
removal of metabolic waste
 EFFECTS ON THE RESPIRATORY SYSTEM
 Percussion and vibration techniques of
massage assist the removal of secretion
from the larger airways, though their
effect on the smaller airway is
controversial
 Increased secretion clearance after chest
physiotherapy both in adult and paediatric
group can be the result of percussion and
vibration loosening and advancing
secretions from the airways more centrally
 EFFECTS ON THE SKIN:
 Massage generally improves the nutritive status
of skin. Following massage the temperature of
skin rises.
 Massage facilitates the movement of skin over
the subcutaneous structures
 As a result skin becomes soften, more supple
and finer
 After prolonged massage the skin also becomes
tough, more flexible, elastic and its sensitivity is
reduced.
 PSYCHOLOGICAL EFFECTS
 Massage can lower the psycho emotional and
somatic arousal such as anxiety and tension
 During massage treatment a close contact is
established between therapist and pt, which
help to overcome the feeling of strangeness
and anxiety
THERAPEUTIC USES

1. TO IMPROVE MOBILITY OF SOFT TISSUE

T he skin, fat, fascia, muscle and ligament are soft tissues of body
Any injury or inflammation to these soft tissues lead to adhesion
formation
Which decreases their mobility and cause pain
After inflammation the new granulation tissue formed during the
process of healing is usually oedematous
This is due to the presence of a protein rich fluid which leaks into
tissue space from the capillaries in the process of
neovascularisation.
The to and fro movement of massage mechanically breaks down the
adhesion and facilitates the free movement of adherent
structure
The aim of the massage is to prevent the adherence of recently
formed soft tissue and also to break the adherent scar tissue
established in long standing cases
 The various conditions in which massage is used
for mobilization of soft tissue are:
 Tendinitis
 Tenosynovitis
 Fibrositis
 Muscular injury
 Ligament sprain
 Post surgical scar
 Post burns contracture
 Pre op and post op cases in plastic, and
reconstructive surgery
2. MUSCLE SPASM AND PAIN
 Spasm is the increased muscle tone in a localized area
 It is one of the primary responses of body to pain or injury
 The increase in muscle tone is a protective mechanism which helps
to prevent further damage by restricting the movement
 Often this contracted state of muscle is maintained for long periods
and itself becomes the cause of pain
 Physiologically the spasm occurs capillary constriction which
reduces the blood flow
 Circulatory restriction results in limitation of flow of nutrients and
oxygen to the area and retention of waste product
 More spasm leads to more ischemic pain and less flexible tissue
 This vicious cycle of pain spasm pain is advanced and spasm persist
 This cycle can be broken by massage
 Massage interferes with the cycle by reducing the pain
3. REDUCTION OF OEDEMA
 Oedema is the accumulation of tissue fluid in
the exracellular space
 Untreated oedema is an established causative
factor for delayed healing, pain as well as for
decreased mobility with subsequent
compromised functional use of the affected part
 Massage reduces oedema utilizing its
mechanical effect of forcing the fluid into the
drainage channels
4. ENHANCEMENT OF CIRCULATION
 Massage has been used throughout the ages as a
treatment for cold extremities, where the blood supply is
decreased due to the vasoconstriction in response to the
cold
 The rubbing activity causes vasodilatation and thus
increases the temperature of the affected part of the body
 The increased circulation following massage is also utilised
in the management of sports specific conditions
 Pre activity massage brings more blood and oxygen to the
massaged part and thus helps in warming up of the
muscle
 Post activity massage removes excess of lactic acid and
other metabolites accumulated in the muscle and is said
to decrease the severity of delayed onset muscle soreness
5. MOBILISE SECRETIONS IN THE LUNGS
 Certain techniques of massage (i.e. clapping,
vibration and shaking) are exclusively used for
the management of chest disorders.
 Massage finds a major role in the treatment of
those chest disorders where increased and
viscid secretions are the source of problem
 In disease like chronic bronchitis, emphysema,
cystic fibrosis, bronchiectasis etc. there occurs
increased production of sputum which
accumulates and dries up and blocks the small
respiratory pathways
6. GENERAL AND LOCAL RELAXATION
 The importance of touch as a means of
communication and its importance in imprating a
sense of well being and confidence cannot be
underestimated
 Psychologically and emotionally massage has been
used since ages to enhance a feeling of well being
and relaxation
 Massage has been shown to have a beneficial
influence on development, attitudes and emotional
status of a baby
 It also observed that massage techniques promote
two to three times faster recovery of psychological
and physiological status of athelets
7. MASSAGE AND OBESITY
 Deep mechanical massage has been advocated
as an alternative or adductive therapy for the
contouring of subcutaneous fat and as a
treatment for cellulite
 Till today, no controlled clinical trail has
established the role of massage in the reduction
of obesity
 Though several equipment based on the
principles of vibratory massage is marketed for
this purpose
8. MASSAGE AND AIDS
 No of studies have appeared in the literature
reporting the increasing use of massage by
AIDS patients
 The most important role of massage in the
management of these pt groups may exist in
the area of stress reduction
 Several studies have documented that massage
or touch helps to reduce anxiety, depression
and other stress related symptom in this patient
9. MASSAGE AND CANCER
 Many people with cancer experience pain,
anxiety and mood disturbance
 Conventional treatment do not always
satisfactorily relieve these symptoms and some
patients may not be able to tolerate their side
effects
 It is suggested that pts who receive massage
have less procedural pain, nausea and anxiety
and report improved quality of life
CONTRAINDICATIONS

 GENERAL CONTRAINDICATIONS
1. HIGH FEVER: Fever is generalized rise of body temperature.
It is one of the systematic manifestations of inflammation.
Massage is not indicated in high fever as it may increase
the overall body temperature. This will further increase the
metabolic rate which is already elevated due to fever.
2. SEVERE RENAL AND CARDIAC DISEASE: oedema is a
feature of renal and cardiac conditions as evident in cardiac
failure and in nephrotic syndrome. Chest percussion has
adverse effects as may provoke the onset of cardiac
arrhythmia and subsequent fall in cardiac output and
partial pressure of oxygen in blood. These effects may
prove to be fatal in severe cardiac diseases. The different
positioning adopted during the massage treatment may
also not suitable for these patients. Therefore massage in
contraindicated for these patients
3. Deep X-ray therapy: deep radiotherapy has a
devitalizing effect on the body tissues. In all
irradiated tissues, be it normal or abnormal, the
vascular changes are prominent. During immediate
post irradiation period vessel may show only
dilation. Later on or with higher dose immediately
after sometime, a variety of regressive changes
appear which range from endothelial cell swelling
to the total necrosis of the wall of the small
vessels. Affected vessels may thrombose or even
rupture, leading to haemorrahge. In this stage
tissue will not sustain any mechanical trauma.
Since massage is mechanical in nature tissues may
react abnormally during manipulations leading to
more harmful effects
4. osteoporosis: osteoporosis is a bone disease characterized by
a decrease in the absolute amount of bone mass significant
to render the skeleton vulnerable to fractures. The skeleton
becomes fragile and may not tolerate the pressure and force
applied to body like kneading, vibration, tapotement etc.
5. Severe spasticity: spasticity is the abnormal increased tone
of muscles due to lesion of upper motor neuron. This is
characterized feature of all UMNL including hemiplegia,
cerebral palsy, spinal cord injury, multiple sclerosis etc.
massage should not be used in these conditions.
6. Very hairy skin: rubbing the hairy skin especially opposite to
the direction of the hair follicle is painful. Usually massage is
not administered to a very hairy skin. But it is a relative
contraindication as excessive hair can be shaved off and
part can be massaged. Heavy oil lubrication of the area prior
to massage can also reduce the chance of hair pulling
7. Patient preference: on account of social,
religious, cultural and personal reasons some
people do not like massage. They also feel
embarrassed while exposing the body part
during the massage, especially if therapist is of
opposite sex. In these situations as far as
possible the people wish must be respected
 LOCAL CONTAINDICATIONS
1. ACUTE INFLAMMATION: a. massage exacerbate the
vascular changes taking place during acute
inflammatory period, i.e. increased blood flow,
vasodilation as well as increase in vascular permeability
and makes the condition worse. As the effect of
massage on vasculature is very similar to that occurring
during acute inflammation, massage during
inflammation will further increase swelling, pain,
tenderness and may lead to more tissue damage
b. Granulation tissue (formed 48 to 72 hours after injury)
has a very delicate blood supply which can easily be
damaged by movements and shearing forces of
massage maneuvers. This interferes with repair process
and delays healing
2. Skin disease: massage is contraindicated in the presence
of infectious skin diseases like eczema and other weeping
conditions, characterised by pruritus, oedematous
vesicle, pustules and papules for the following reasons:
- Infection may spread from one part to other
- Therapist may get cross infection
- Massage is painful to the patient
3. Recent fracture: fracture is the break in the continuity of
bone. In initial stage massage should not be given as it
disturbs the healing process. If the fracture is
immobilized massage may be administered to the area
proximal to the fracture site. It gives comfort to pt by
reducing selling and relieving pain and tension in the
area, but fractured site must be avoided
4. Varicose vein: this is a condition in which due to
incompetency of valves, veins become dilated and
tortuous. This results in the venous congestion and
walls of vein become thin. In this condition massage
may provoke complications like haemorrhage. Thin
veins may not tolerate even minor trauma. It may
rupture and due to high pressure in congested
vessels, profuse bleeding may result
5. Thrombosis and arteriosclerosis: this condition is
characterised by formation of fatty plaque in
arterial lumen. This is known as thrombus. Massage
should not be given in the presence of thrombus as
emboli may break off from the wall due to
mechanical squeezing of blood vessels
6. Myositis ossificans: in this condition there occurs
callus formation in soft tissues. The joint capsule
and periosteum is stripped from the bone by
violent displacement. Blood collects under the
stripped soft tissue forming haematoma. This give
rise to limitation of movement and pain
7. malignancy: metastasis is the essential feature of
all malignant tumors. Tumor cells disseminate
through lymphatic and haematogenous pathways.
Massage promotes tumor metastasis it is prudent
to avoid massage directly over known tumors or
even predictable metastasis and special cautions
should be exercised in patients with bony
metastasis as they are prone to fracture
 Open wound: massage over open wounds, cuts
and bruise is not only painful but may further
damage the healing tissue. Mechanical
movement to wound which massage will
produce is an established causative factor for
delayed healing of tissue
 Poisonous foci: massage should not be
administered in case of snake bite, stings and
insect bite. Massage increases the circulation
and may facilitate the release of poison into
circulation, leading to serious systematic effects