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Therapeutic massage. Objectives. At the end of the lecture students should be able to: Define and understand the concept of therapeutic massage . Explain different effects of massage . List indications and contra-indications of therapeutic massage .

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At the end of the lecture students should be able to:

  • Define and understand the concept of therapeutic massage.
  • Explain different effects of massage.
  • List indications and contra-indications of therapeutic massage.
  • Summarize the precautions and considerations of massage application.
  • Discuss the basic techniques of therapeutic massage and its types.
history of massage
History of Massage
  • Massage is derived from 2 sources.
    • Arabic verb mass “to touch”
    • Greek word massein “to knead”
  • Egyptians, Romans, Japanese, Persians, & Chinese were known to practice massage therapy.
history of massage1
History of Massage
  • Sweden – early 19th century, Peter Ling (acknowledged founder of curative gymnastics) – appears to be founder of modern day massage techniques, incorporated with French massage techniques
  • Techniques have changed dramatically in the past 50 years
    • Based on research by Albert Hoffa (1859-1907), James Mennell 1880-1957), & Gertrude Beard (1887-1971).
    • Scientific basis to massage was added.
    • Late 1980’s, Amer Massage Therapy Association was organized (1992 – Nat’l Cert. Exam. For Therapeutic Massage & Bodywork was formed).
  • Massage is therapeutic manipulation of the soft tissues of the body used to achieve normalization of those tissue.
  • It can be defined also as an act of rubbing, kneading, or stroking the superficial parts of the body for the purpose of modifying nutrition, restoring power of movement or breaking down adhesions.
  • Tense muscles
  • Scar tissue
  • Chronic edema
  • Pain
  • Anxiety, and depression
  • Respiratory problems
  • Chronic constipation
  • Skin disorders and infections
  • Malignant tumors
  • Recent and unhealed scars
  • Open wound
  • Recent fracture
  • Atrophic skin

Edema due to any heart, lung, liver, or kidney dysfunction

  • Venous Thrombi
  • Patients on anti-coagulant drugs
  • Skin grafts
basic requirements
Basic Requirements
  • Ethical issues as patientprivacy.
  • Understanding of the underlying pathology.
  • Understanding ofbasic principles of massage (manual dexterity, coordination, & concentration). Also, P.T. must exhibit patience & courteousness.
  • Hand preparation

Hands must be clean, warm, dry & soft. Nails must be short and smooth.


Patient should be warm, well draped and in a comfortable relaxed position. The body part may be elevated if necessary.

  • Massage should begin with superficial stroking. Each stroke should start just below the joint and finish above it so that strokes overlap.
  • Pressure should be in line with venous flow.
  • Bony prominences & painful joints should be avoided if possible.

Massage media

  • It is used to decrease friction between patient’s skin and clinician’s hand e.g. lotions, oil, powder or analgesic balms.
  • More medium should be used on hairy areas.
  • Massage can be given without any medium as during petrissage, lubricants interfere with the kneading & lifting. Also, during friction massage, lubricants may interfere with the desired results.


Treatment table should be:

  • Adjustable in height.
  • Equipped with a face/nose hole.
  • Made in at least three sections, of which the two end portions can be lifted.
  • Adjustable forearm rests.
  • Casters and lift/lock mechanism.
general procedures
General Procedures

Therapist Position

  • P.T. must assume good posture to prevent fatigue & backache.
  • Weight should be evenly distributed on both feet.
  • He must be able to fit hands to the contour of the area being treated.
  • A good position is required to allow correct application of pressure and rhythmic strokes.

Depth of Pressure

  • It is the amount of force a stroke applies to the tissue.
  • It depends on the desired result. It should be increased gradually and with great care depending on patient’s tolerance.
Massage should never be painful, except possibly for friction massage.
  • Direction of forces should be applied in the direction of the muscle fibers.
  • Each session should begin & end with effleurage.


It is how fast or slow a stroke is performed depending on the desired response, relaxation or stimulation.

For example, compression applied with slow, rhythmic presses flushes lactic acid out of a muscle, while compression done quickly pumps fresh blood into the muscle and prepares it for action. In general, slow strokes soothe while fast strokes wake up.



  • It is referred to the overall tone of the massage or the regularity with which a stroke is applied.
  • It can be slow or fast, depending on the desired result; therapists should avoid jerky movement.


  • It is the length of time each stroke lasts during its application or the length of time the stroke remains on any given body part.
  • If the desired result is relaxation, a slower and longer stroke is used. Longer, here, refers to the amount of tissue traversed, for example, the entire leg from foot to top of thigh or the entire time spent on the leg.


  • It is the pathway of the stroke. On the extremities, the direction is toward the heart.

For example applying effleurage from the foot, the lower leg, the upper leg to the upper thigh.



  • It is the number of times each stroke is performed. In general, each stroke is performed at least three times before transition to another stroke or body area.

Physiological Effects

  • Depending on the amount of pressure applied & the speed of the stroke, many results can occur:
    • Light, slow strokes evoke systemic relaxation
    • Fast, deep strokes increase blood flow to the area

Different body systems are affected by massage.

cardiovascular system
Cardiovascular system
  • Vigorous massage improves circulation by increasing venous return. No increase in cardiac output, BP or arterial blood flow.
  • Decreased HR & BP are obtained if the purpose is relaxation.

Removal of metabolites and overcoming venous stasis.

  • Increased capillary dilatation.
  • Stimulation of cell metabolism.
  • Resolution of chronic edema and hematoma.
respiratory system
Respiratory system

Massage can loosen adherent mucous from the bronchial tree and improve respiration.

musculoskeletal system
Musculoskeletal system
  • Improves muscle length.
  • Prevents spasm.
  • Obtains relaxation induced by slow superficial stroking of skin.
  • Obtains stimulation through quick brisk strokes, causing muscle contraction.
  • Increases extensibility of the connective tissues.

Massage can reduce pain by:

  • Decreasing pressure from swelling or edema (mechanical pain).
  • Relieving muscle spasm.
  • Increasing blood flow & encouraging waste products removal (chemical pain).
  • Activating sensory nerves that inhibit pain.
mechanical effects
Mechanical Effects
  • Techniques that stretch a muscle, elongate fascia, or mobilize soft tissue adhesions or restrictions are all mechanical techniques
  • Mechanical effects are always accompanied by some reflex effects.
  • Muscle – massage is done either for mechanical stretching or to relieve pain associated with trigger points.
Skin massage increases skin temperature, increase sweating & decrease resistance to electrical current.
  • It also softens the skin.
  • It removes dead cells present on the skin surface.
  • It stretches & breaks down fibrous tissues.

Stroking of the skin:

  • When performed with palm of hand, it stimulates deep tissues.
  • When performed with fingertips, it stimulates sensory nerves.

In superficial, rhythmic stroking, the hands contour the body or relates to direction of underlying muscles.

In deep stroking, the hands follow course of veins & lymph vessels.

  • It may be performed slowly for relaxation or rapidly to encourage blood flow & stimulate the tissues.
  • One hand should always be in contact with skin.
  • Light effleurage is performed at beginning & end of massage or may be used between petrissage strokes.
    • At beginning – relaxes the body area to be treated
    • At end – calms down any irritated areas.
  • Petrissage is also referred to milking or wringing
  • It is lifting & kneading of skin, subcutaneous tissue & muscles.
  • Performed with fingers or hand.

It is often performed without lotion.

  • Skin is gently lifted between thumb & fingers or fingers & palm & gently rolled & kneaded in the hand.
  • The stroke is perhaps the hardest stroke since it involves the use of the “C” part of the hand (between the thumb and first finger, or the “webbing” as a primary pressure point.

It frees adhesions by stretching & separating the muscle fiber, fascia, & scar tissue while assisting venous return & milking out waste products.

  • Petrissage always follows effleurage to further warm the muscle tissue.
  • The goal is to mobilize muscle, tendon, scar tissue & separate adhesions that restrict movement & cause pain.
  • Types:


    • Applied with thumbs working in circular motion
    • Effective in treating muscle spasm & trigger points.
    • Applied with thumbs or fingertips stroking the tissue from opposite directions.
    • It reaches the deep tissues.
    • Begins lightly and then move to firmer strokes.
    • Muscles should be placed in relaxed position
    • Should be avoided in acute conditions.
    • Effective in tendonitis or adhesions.
  • Gentle tapping or pounding of the skin. It is a percussion stroke with the blow being immediately pulled off the muscle as soon as the hand strikes.

Types of tapotement:

  • Hacking is performed using the ulnar side of the hands (little finger side) in alternating blows with the wrists kept loose.

Beating is performed with the ulnar side of the hand and loose fists.

  • Cupping is performed with the palmar side of the hand in concave position.

Slapping is performed with the palmar side of the hand with usually more finger surface than palm.

  • Tapping (as beating) and pinching are both performed using the fingertips.


physiological effects of tapotement
Physiological Effects of Tapotement

It stimulates initially but can become sedating with prolonged use. In this case, tapotements promote relaxation, desensitize irritated nerve endings, and break up congestion in the lung.

N.B. Tapotement is not performed over the kidneys or bony surfaces.

vibration and shaking
Vibration and Shaking

Vibration is a fine, gentle trembling movement of the tissues which is performed by hand or fingers. Shaking is a large movement performed more vigorously.



  • The palmar surface of the hand is placed on the body part. The movement may either be gentle, in which case it is known as 'vibration', or vigorous, which is referred to as 'shaking'. Gentle vibration can be performed using just the fingertips along course of a nerve.


  • Vibration along the course of a nerve is helpful for restoring and maintaining the functions of a nerve and the muscles supplied by them. It is particularly useful in cases of paralysis or weakness.
  • Gentle vibration also can decrease muscles hypertonicity in the neurological disorders.

Vibrating and shaking can be performed on the abdominal area to aid digestion. It can be used to promote tone in the colon and to relieve constipation.

  • Vibration and shaking over the thoracic area and chest is particularly beneficial for respiratory problems, sometimes in combination with the tapotement movements.