Massage Movements and Techniques
Content
Swedish Massage Movements and Techniques
Touch is the first technique in developing a therapeutic relationship. Touch may be in the form of a handshake or a pat on the shoulder. In the course of a massage, touch constitutes the first and last contact of the practitioner with the client. All massage techniques use physical contact, but the quality and sense of touch conveys the intent and power of the movements. Touch is the primary communication tool used by the massage therapist. The factors that must be considered as components in the application of massage techniques are: the direction of the movement, the amount of pressure, the rate and rhythm of the movements, the medium (type of lubricant) used, the frequency and duration of the treatment, the position of the client, and the position of the massage practitioner. Direction can move from the center of the body out (centrifugal) or from the extremities in toward the center of the body (centripetal). It can proceed from origin to insertion of the muscle following the muscle fibers, transverse to the tissue fibers, or in circular motions. Depth of pressure (compressive stress) can be light, moderate, deep, or variable. Drag is the amount of pull (stretch) on the tissue (tensile stress). Light pressure movements are applied over thin tissues or over bony parts. Heavy pressure movements are indicated for thick tissues or fleshy parts of the body. Speed of manipulations can be fast, slow, or variable. Rhythm refers to the regularity of application of the technique. If the method is applied at regular intervals, it is considered even or rhythmic. If the method is disjointed or irregular, it is considered uneven or non-rhythmic. Gentle movements are applied with a slow rhythm and are soothing and relaxing. Vigorous movements are applied in a quick rhythm and are stimulating. Frequency is the rate at which the method repeats itself in a given time frame. In general, each method is repeated three times before moving or switching to a different approach. Duration is the length of time that the method lasts or the manipulation stays in the same direction.
Massage Movements
Massage movements are too therapeutic massage what words are to language or notes to music. To practice massage, some understanding of the movements is critical to successfully performing a therapeutic massage. There are a number of massage movements and possible combinations of strokes, so a massage can be tailored to the specific needs of each client. The following movements are the fundamental manipulations used in Swedish massage and are the foundation of most massage styles practiced today. The massage practitioner must understand the indications for and effects of the manipulations. The more mastery therapists have of the movements, the better they are able to choose and combine movements according to each situation.
Effleurage
The current term for effleurage is “gliding stroke.” Effleurage originates from the French verb meaning “to skim” and “to touch lightly on.” The most superficial applications of this stroke
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do this, but the full spectrum of effleurage is determined by pressure, drag, speed, direction, and rhythm, making this manipulation one of the most versatile. There are two varieties of effleurage: superficial and deep. Superficial gliding strokes employ a very light touch. In gliding strokes, the pressure becomes firmer as the hand glides over the surface of the body. The technique of effleurage or gliding is accomplished either with the fingers, thumbs, palm of the hand, knuckles, or the forearm. Superficial gliding strokes are generally applied prior to any other movement. This type of stroke accustoms the client to the practitioner’s contact and allows the practitioner to assess the body area being massaged. Increased pressure adds a compressive force and drag to this stroke. Light stroking is done with the fingertips or palm of the hand. Small body areas such as the fingers can be grasped and surrounded as effleurage is applied to the entire area. The surface contact increases with full hand and forearm application of the manipulations. Superficial applications, which stay within the skin and subcutaneous layer, tend to have a more reflexive effect. The term deep gliding indicates that the manipulation uses enough pressure to have a mechanical effect. Deep gliding strokes are especially valuable when applied to the muscles. It is most effective when the part under treatment is in a state of relaxation. This type of stroke has a stretching and broadening effect on muscle tissue and fascia. It also enhances the venous blood and lymph flow. Deep gliding generally follows the direction of the muscle fibers. On the extremities, the movements are always directed from the end of a limb toward the center of the body. When using deep gliding strokes, the practitioner must use good body mechanics to prevent strain and overuse syndrome injuries. Another variation of a gliding movement is feather-stroking. Feather stroking movements use very light pressure of the fingertips or hands with long flowing strokes. The application of feather stroking, sometimes called “nerve stroking,” is usually done from the center outward and is used as a final stroke to individual areas of the body. Two or three such strokes will have a slightly stimulating effect on the nerves, while many repetitions will have a more sedating response. 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. After the application of the initial touch or resting position, effleurage is often done next in sequence, especially if a lubricant is used. It is also a good method to use when evaluating for hard and soft tissue, hot and cold areas, or areas that seem stuck. Effleurage is the preferred method for abdominal massage.
Petrissage
Petrissage, from the French verb “petrir” meaning “to knead,” requires that the soft tissue be lifted, rolled, and squeezed by the massage therapist. Because skin and the underlying muscles cannot be lifted without first pressing into them, compression is sometimes classified as petrissage. The main purpose of this manipulation is to lift tissue. Once lifted, the full 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.
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Petrissage is very good for decreasing muscle tone. The lifting, rolling, and squeezing action affects the stretch receptors in the muscle. When the belly of the muscle is squeezed, it feels less stretched. When lifting, the tendons are stretched, thus increasing tension in both the tendons and the stretch receptors. The result of this sensory input is to reflexively relax the muscle to keep it from harm. Petrissage is a method of “tricking” the muscle into relaxation. Petrissage has the mechanical effect of softening and creating space around the actual muscle fibers, 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. A variation of this lifting manipulation is skin-rolling. In this technique, only the skin is lifted from the underlying muscle layer. Whereas deep petrissage attempts to lift the deep muscular component away from the bone, skin-rolling lifts only the skin. It has a warming and softening effect on the superficial fascia, causing reflexive stimulation to the spinal nerves, and is an excellent assessment method. Skin-rolling is one of the very few massage methods that is safe to use directly over the spine. Although petrissage is very effective in softening and relaxing tissue, it is more difficult and energy-consuming for the massage practitioner to use. The fingers should be used as a unit along with the thenar eminence of the thumb. Excessive use of this manipulation should be avoided. It is better to use petrissage intermittently with effleurage and compression, which do not require labor-intensive use of the hands. Another variation of petrissage known as compression has developed as a distinct manipulation in recent years. It has always been the main method used in shiatsu and other oriental approaches. Very specific pinpoint compression is called direct pressure, or ischemic compression, and is used on acupuncture points (motor points) and trigger points. Compression moves down into the tissues with varying depths of pressure. The superficial application resembles the resting position but uses more pressure. The manipulations of compression usually penetrate the subcutaneous layer, while in the resting position they stay on the skin surface. Much of the effect of compression results from pressing tissue against the underlying bone, causing it to spread and be squeezed from two sides. As with effleurage, the deeper the pressure, the more mechanical the effect will be. Likewise, the more superficial the pressure, the more reflexive the effect will be. Because compression stimulates the muscles and nerve tissue, it is less desirable for a relaxation or soothing massage. Compression can be done with the point of the thumb or stabilized finger, palm or heel of the hand, fist, knuckles, forearm, elbow, and in some systems, the knee and heel of the foot.
Friction
Friction manipulation prevents and breaks up local adhesions in connective tissue, especially over tendons, ligaments, and scars. This method is not to be used over acute injury or fresh scars. Modified use of friction, once the scar has stabilized or the acute phase has passed, may prevent adhesions from developing and may promote a more normal healing process. The movement in friction is usually transverse to the fiber direction; it is generally performed for thirty seconds to ten minutes, with some authorities suggesting twenty minutes. The result of this type of friction is the initiation of a small, controlled inflammatory response. The chemicals released during this type of manipulation causes reorganization of the connective tissues in a way that can be controlled by the practitioner.
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Connective tissue has a high water content. In order for the connective tissue to remain pliable, it must remain hydrated. Friction increases the water-binding capacity of the connective tissue ground substance. Friction is a mechanical approach best applied to areas of high connective tissue concentration such as the musculotendinous junction. Another use for friction is to combine it with compression. The combination adds a small stretch component. This application has a mechanical, chemical, and reflexive effect, and is the most common approach today. There are three basic variations of friction: longitudinal, circular, and deep. Additional variations of friction include rolling, chucking, and wringing. Rolling is a rapid back-and-forth movement with the hands, in which the flesh is shaken and rolled around its axis, or the imaginary centerline of the body part. Chucking is accomplished by grasping the flesh firmly in one or both hands and moving it up and down along the bone. It is a series of quick movements along the axis of the limb. Wringing is a back-and-forth movement in which both of the practitioner’s hands are placed a short distance apart on either side of the limb. It resembles wringing out a wash cloth. The hands work in opposing directions, stretching and twisting the flesh against the bones in opposite directions.
Vibration
Vibration is a very powerful stroke, if it can be done long enough and at an intensity sufficient to produce reflexive physiologic effects. It is described as rapid back-and-forth movements administered by alternating contraction/relaxation of the forearm musculature. Manual vibration can be used successfully by the massage therapist to tone muscles by applying the technique at the muscle tendons for up to thirty seconds. Because vibration is used to “wake up” nerves, it is a good method to stimulate nerve activity. The nerves of the muscles around a joint also innervate the joint itself. Muscle pain is often interpreted by the client as joint pain and vice versa. Used specifically and purposefully, vibration is a great massage manipulation to shift joint pain perception. A variation of vibration known as shaking is a massage method that is effective in relaxing muscle groups or an entire limb. Shaking manipulations confuse the positional sensors, which causes the muscles to relax. The sensory input is too unorganized for the integrating systems of the brain to interpret, and going limp is the natural response in such situations. Shaking also warms and prepares the body for deeper bodywork. Shaking is sometimes classified as a vibration even though the application is very different. Shaking begins with lift and pull components while vibration begins with compression. Either a muscle group or a limb is grasped, lifted, and shaken. Shaking is not a manipulation to be used on the skin or superficial fascia, nor is it effective to use on the entire body. Rather, it is best applied to any large muscle groups that can be grasped and to synovial joints. Good areas for shaking include the upper trapezius and shoulder area, biceps and triceps groups, hamstrings, quadriceps, gastrocnemius, and in some instances the abdominals and the pectoralis muscles close to the axilla. The joints of the shoulders, hips, and extremities also respond well to shaking. The larger the muscle or joint, the more intense is the method. 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 this method. Another variation of vibration is known as rocking, a soothing and rhythmic form of shaking that has been used since the beginning of time to calm people. Rocking works through
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the vestibular system of the inner ear and feeds sensory input directly into the cerebellum. It is probable that the 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 is affected, initiating reflex nervous system mechanisms. Rocking is rhythmic and should be applied with a deliberate and full-body movement. Rocking involves the up-and-down and side-to-side movement of shaking, but there is no flick or throw-off 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 client’s rhythm can be sensed. At this point, the 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. Many reflex nervous system responses are elicited by the rocking of the body during effleurage, petrissage, and compression. 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, however, work on all the tissues through stimulation of the nervous systems, primarily the proprioceptors of the muscles and joints.
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 at a fast rate. The blows are directed downward to create a rhythmic compression of the tissue. Tapotement is divided into two classifications: light and heavy. The difference between light and heavy tapotement is 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 such as the pleura in the chest cavity. Tapotement, or percussion, 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. 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. In tapotement, two hands are 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. Heavy tapotement should not be done over the kidney area, or anywhere there is pain or discomfort. Proper methods are as follows:
Hacking. Applied with both wrists relaxed and the fingers spread, only the little fingers or the ulnar side of the hand strikes the surface in hacking. The other fingers hit each other with a springy touch. Hacking is used with the whole hand on the larger soft tissue areas such as the upper back and shoulders. Cupping. Fingers and thumbs are placed as if making a cup. The hands are turned over and the same action as hacking is done. Used on the anterior and
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posterior thorax, cupping is good for stimulation of the respiratory system and for loosening mucus.
Beating and pounding. These moves are done with a soft fist with knuckles down, or vertically with the ulnar side of the palm. Beating and pounding is done over large muscles such as the buttocks and heavy leg muscles. Slapping (splatting). The whole palm of the flattened hand makes contact with the body. This technique is good to use on the bottom of the feet. Tapping. The palmar surface of the fingers alternately taps the body area with light to medium pressure. This method is good around the joints, on the tendons, on the face and head, and along the spine.
Joint Movement
To understand joint movement, you must first understand the joint. Joint movement techniques focus on the synovial or freely movable joints of the body. To a lesser degree, the joints of the vertebral column, hand, and foot are also considered. Muscles do not directly influence these joints; they move through indirect muscle action. Joints allow us to move. Joint position and velocity receptors inform the central nervous system regarding where and how the body is positioned against gravity and how fast it is moving. This sensory data is the major determining factor for muscle tone patterns. Joint movement involves moving the jointed areas within the physiologic limits of range of motion of the client. Active joint movement means that the client moves the joint by active contraction of muscle groups. Active assisted movement means that both the client and therapist move the area. Passive joint movement occurs when the client’s muscles stay relaxed and the massage therapist moves the joint with no assistance from the client. Whether active or passive, joint movements are always done within the comfortable limits of range of motion of the client. The shape and fit of the bones at the joint determine anatomic barriers. Physiologic barriers are caused by the limits of range of motion imposed by protective nerve and sensory function. This type of barrier often displays itself as stiffness, pain, or a “catch.” When using joint movement techniques, it is important to remain within the physiologic barriers and to gently and slowly encourage the joint to increase the limits of the range of motion. When a normal joint is taken to its limit, there is usually still a bit more movement possible, a sort of springiness in the joint. This is called a soft end-feel. When there is abnormal restriction, the limit does not have this spring, but like a jammed door or drawer, the joint is fixed at the barrier, and any attempt to take it further is uncomfortable and distinctly “binding” or jamming, rather than springy. This is called a hard end-feel. When doing passive joint movement, feel for the soft or hard end-feel of the joint range of motion. When incorporating joint movement into the massage, follow these basic suggestions:
If possible, do active joint movement first. Assess range of motion by having the client move the area. Then have the client move the area against your stabilizing force to increase the intensity of the signals from the contracting muscles, which discharges the nervous system. Incorporate any or all of the previously discussed massage methods.
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Once the tissue is warm and the nervous system is relaxed, perform the passive range of motion / joint movement.
Summary
In general, massage manipulations and techniques either stimulate or inhibit a response. When thinking in terms of muscle, think of toning (causing it to contract) or relaxing (reduction of the neural stimulation causing contraction) the muscle. All massage methods use forms of external sensory information that can stimulate or inhibit body processes, depending on their use. Massage techniques that move through the skin to the underlying tissue tend to be more mechanical and will stimulate localized chemical responses. Massage techniques that stay within the skin and superficial fascial layer tend to have a more direct effect on the nervous system. Many sensory nerves are located in the skin. These methods also tend to stimulate the release of hormonal and other body chemicals that provide for a general systemic (whole body) effect. Massage techniques that move the body, causing muscles to contract and joint positions to change, deliver sensory input to the proprioceptors and are more reflexive in nature. Massage techniques that stretch (pull on) soft tissues are reflexive, mechanical, and chemical in their effect. The practitioner must also understand the movement to be applied to a particular part of the body. For example, light movements are applied over thin tissues or bony parts, heavy movements are indicated for thick tissues or fleshy parts, gentle movements are applied with a slow rhythm and are soothing and relaxing, and vigorous movements are applied in a quick rhythm and are stimulating. While applying the movements, the practitioner must pay close attention to the overall response of the client as well as the response of the tissue or body part to which the manipulation is being applied and adjust the application accordingly.
Questions for Discussion and Review: “Massage Movements and Techniques”
1. What is the first technique in developing a therapeutic relationship? 2. What factors must be considered as components in the application of massage techniques? 3. What is the direction of centrifugal movements? 4. What is the direction of centripetal movements? 5. What is meant by depth of pressure? 6. What are the variations of depth of pressure that can be used during a massage? 7. What is drag? 8. Where are light pressure movements used? 9. Where are heavy pressure movements used? 10. What are the variations of speed that can be used during a massage? 11. What is rhythm? 12. What are the effects of massage movements that have a gentle and slow rhythm? 13. What are the effects of massage movements that are vigorous and have a quick rhythm? 14. What is frequency? 15. What is duration? 16. What is effleurage? 17. What are the different variations of effleurage? 18. When is superficial gliding applied? 19. What are the benefits of superficial gliding? 20. What are the effects of superficial applications of effleurage? 21. What are the effects of deep applications of effleurage? 22. When is deep gliding most effective?
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23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75.
What are the effects of deep gliding on the muscle and connective tissue? What are the effects of deep gliding on the circulation? Which direction does deep gliding usually follow? What should the practitioner be aware of when doing deep gliding? What is feather stroking? What is another name for feather stroking? How is feather stroking performed? What are the effects of feather stroking? What are the effects of slow, superficial gliding strokes? What are the effects of fast, superficial gliding strokes? What are the effects of a deeper gliding stroke at a slower rate? What is petrissage? What is the main purpose of petrissage? How is petrissage done? What is the effect of petrissage on the muscle tissue? What is the effect of petrissage on the tendons? What is skin-rolling? What are the benefits of skin-rolling? Where did compression come from? Where is ischemic compression performed? What are the effects of compression? Petrissage is used as a stimulating or relaxing technique? What is friction? What are the effects of friction? When is this massage technique contraindicated? Which direction is friction applied? What are the effects of friction on the connective tissues? What are the effects of combining friction with compression? What are the three basic variations of friction? What are three additional variations of friction? What is rolling? What is chucking? What is wringing? What is vibration? What is the effect of vibration on the nerves? What is shaking? What are the effects of shaking? How is shaking performed? What are some good areas for shaking? What is rocking? How does rocking work? What are the effects of rocking? What is tapotement? What are the two classifications of tapotement? What type of manipulation is tapotement? How does tapotement work? What are the five different methods of tapotement? What is hacking? Where is hacking done? What is cupping? Where is cupping done? What is beating and pounding? Where is beating and pounding done?
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76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96.
What is slapping? Where is slapping done? What is tapping? Where is tapping done? What are active joint movements? What are active assistive joint movements? What are passive joint movements? Describe what “soft end-feel” means. What type of joint movement should be done first with a client? When should passive range of motion be performed? What are the general effects of massage? What are the effects of massage techniques that move through the skin? What are the effects of massage techniques that stay within the skin and superficial layer? What are the effects of massage techniques that move the body? What are the effects of massage techniques that stretch soft tissues? Where should light movements be applied? Where should heavy movements be applied? How should gentle movements be applied? What are the effects of gentle movements? How should vigorous movements be applied? What are the effects of vigorous movements?
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Touch is the first technique in developing a therapeutic relationship. Touch may be in the form of a handshake or a pat on the shoulder. In the course of a massage, touch constitutes the first and last contact of the practitioner with the client. All massage techniques use physical contact, but the quality and sense of touch conveys the intent and power of the movements. Touch is the primary communication tool used by the massage therapist. The factors that must be considered as components in the application of massage techniques are: the direction of the movement, the amount of pressure, the rate and rhythm of the movements, the medium (type of lubricant) used, the frequency and duration of the treatment, the position of the client, and the position of the massage practitioner. Direction can move from the center of the body out (centrifugal) or from the extremities in toward the center of the body (centripetal). It can proceed from origin to insertion of the muscle following the muscle fibers, transverse to the tissue fibers, or in circular motions. Depth of pressure (compressive stress) can be light, moderate, deep, or variable. Drag is the amount of pull (stretch) on the tissue (tensile stress). Light pressure movements are applied over thin tissues or over bony parts. Heavy pressure movements are indicated for thick tissues or fleshy parts of the body. Speed of manipulations can be fast, slow, or variable. Rhythm refers to the regularity of application of the technique. If the method is applied at regular intervals, it is considered even or rhythmic. If the method is disjointed or irregular, it is considered uneven or non-rhythmic. Gentle movements are applied with a slow rhythm and are soothing and relaxing. Vigorous movements are applied in a quick rhythm and are stimulating. Frequency is the rate at which the method repeats itself in a given time frame. In general, each method is repeated three times before moving or switching to a different approach. Duration is the length of time that the method lasts or the manipulation stays in the same direction.
Massage Movements
Massage movements are too therapeutic massage what words are to language or notes to music. To practice massage, some understanding of the movements is critical to successfully performing a therapeutic massage. There are a number of massage movements and possible combinations of strokes, so a massage can be tailored to the specific needs of each client. The following movements are the fundamental manipulations used in Swedish massage and are the foundation of most massage styles practiced today. The massage practitioner must understand the indications for and effects of the manipulations. The more mastery therapists have of the movements, the better they are able to choose and combine movements according to each situation.
Effleurage
The current term for effleurage is “gliding stroke.” Effleurage originates from the French verb meaning “to skim” and “to touch lightly on.” The most superficial applications of this stroke
1
do this, but the full spectrum of effleurage is determined by pressure, drag, speed, direction, and rhythm, making this manipulation one of the most versatile. There are two varieties of effleurage: superficial and deep. Superficial gliding strokes employ a very light touch. In gliding strokes, the pressure becomes firmer as the hand glides over the surface of the body. The technique of effleurage or gliding is accomplished either with the fingers, thumbs, palm of the hand, knuckles, or the forearm. Superficial gliding strokes are generally applied prior to any other movement. This type of stroke accustoms the client to the practitioner’s contact and allows the practitioner to assess the body area being massaged. Increased pressure adds a compressive force and drag to this stroke. Light stroking is done with the fingertips or palm of the hand. Small body areas such as the fingers can be grasped and surrounded as effleurage is applied to the entire area. The surface contact increases with full hand and forearm application of the manipulations. Superficial applications, which stay within the skin and subcutaneous layer, tend to have a more reflexive effect. The term deep gliding indicates that the manipulation uses enough pressure to have a mechanical effect. Deep gliding strokes are especially valuable when applied to the muscles. It is most effective when the part under treatment is in a state of relaxation. This type of stroke has a stretching and broadening effect on muscle tissue and fascia. It also enhances the venous blood and lymph flow. Deep gliding generally follows the direction of the muscle fibers. On the extremities, the movements are always directed from the end of a limb toward the center of the body. When using deep gliding strokes, the practitioner must use good body mechanics to prevent strain and overuse syndrome injuries. Another variation of a gliding movement is feather-stroking. Feather stroking movements use very light pressure of the fingertips or hands with long flowing strokes. The application of feather stroking, sometimes called “nerve stroking,” is usually done from the center outward and is used as a final stroke to individual areas of the body. Two or three such strokes will have a slightly stimulating effect on the nerves, while many repetitions will have a more sedating response. 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. After the application of the initial touch or resting position, effleurage is often done next in sequence, especially if a lubricant is used. It is also a good method to use when evaluating for hard and soft tissue, hot and cold areas, or areas that seem stuck. Effleurage is the preferred method for abdominal massage.
Petrissage
Petrissage, from the French verb “petrir” meaning “to knead,” requires that the soft tissue be lifted, rolled, and squeezed by the massage therapist. Because skin and the underlying muscles cannot be lifted without first pressing into them, compression is sometimes classified as petrissage. The main purpose of this manipulation is to lift tissue. Once lifted, the full 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.
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Petrissage is very good for decreasing muscle tone. The lifting, rolling, and squeezing action affects the stretch receptors in the muscle. When the belly of the muscle is squeezed, it feels less stretched. When lifting, the tendons are stretched, thus increasing tension in both the tendons and the stretch receptors. The result of this sensory input is to reflexively relax the muscle to keep it from harm. Petrissage is a method of “tricking” the muscle into relaxation. Petrissage has the mechanical effect of softening and creating space around the actual muscle fibers, 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. A variation of this lifting manipulation is skin-rolling. In this technique, only the skin is lifted from the underlying muscle layer. Whereas deep petrissage attempts to lift the deep muscular component away from the bone, skin-rolling lifts only the skin. It has a warming and softening effect on the superficial fascia, causing reflexive stimulation to the spinal nerves, and is an excellent assessment method. Skin-rolling is one of the very few massage methods that is safe to use directly over the spine. Although petrissage is very effective in softening and relaxing tissue, it is more difficult and energy-consuming for the massage practitioner to use. The fingers should be used as a unit along with the thenar eminence of the thumb. Excessive use of this manipulation should be avoided. It is better to use petrissage intermittently with effleurage and compression, which do not require labor-intensive use of the hands. Another variation of petrissage known as compression has developed as a distinct manipulation in recent years. It has always been the main method used in shiatsu and other oriental approaches. Very specific pinpoint compression is called direct pressure, or ischemic compression, and is used on acupuncture points (motor points) and trigger points. Compression moves down into the tissues with varying depths of pressure. The superficial application resembles the resting position but uses more pressure. The manipulations of compression usually penetrate the subcutaneous layer, while in the resting position they stay on the skin surface. Much of the effect of compression results from pressing tissue against the underlying bone, causing it to spread and be squeezed from two sides. As with effleurage, the deeper the pressure, the more mechanical the effect will be. Likewise, the more superficial the pressure, the more reflexive the effect will be. Because compression stimulates the muscles and nerve tissue, it is less desirable for a relaxation or soothing massage. Compression can be done with the point of the thumb or stabilized finger, palm or heel of the hand, fist, knuckles, forearm, elbow, and in some systems, the knee and heel of the foot.
Friction
Friction manipulation prevents and breaks up local adhesions in connective tissue, especially over tendons, ligaments, and scars. This method is not to be used over acute injury or fresh scars. Modified use of friction, once the scar has stabilized or the acute phase has passed, may prevent adhesions from developing and may promote a more normal healing process. The movement in friction is usually transverse to the fiber direction; it is generally performed for thirty seconds to ten minutes, with some authorities suggesting twenty minutes. The result of this type of friction is the initiation of a small, controlled inflammatory response. The chemicals released during this type of manipulation causes reorganization of the connective tissues in a way that can be controlled by the practitioner.
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Connective tissue has a high water content. In order for the connective tissue to remain pliable, it must remain hydrated. Friction increases the water-binding capacity of the connective tissue ground substance. Friction is a mechanical approach best applied to areas of high connective tissue concentration such as the musculotendinous junction. Another use for friction is to combine it with compression. The combination adds a small stretch component. This application has a mechanical, chemical, and reflexive effect, and is the most common approach today. There are three basic variations of friction: longitudinal, circular, and deep. Additional variations of friction include rolling, chucking, and wringing. Rolling is a rapid back-and-forth movement with the hands, in which the flesh is shaken and rolled around its axis, or the imaginary centerline of the body part. Chucking is accomplished by grasping the flesh firmly in one or both hands and moving it up and down along the bone. It is a series of quick movements along the axis of the limb. Wringing is a back-and-forth movement in which both of the practitioner’s hands are placed a short distance apart on either side of the limb. It resembles wringing out a wash cloth. The hands work in opposing directions, stretching and twisting the flesh against the bones in opposite directions.
Vibration
Vibration is a very powerful stroke, if it can be done long enough and at an intensity sufficient to produce reflexive physiologic effects. It is described as rapid back-and-forth movements administered by alternating contraction/relaxation of the forearm musculature. Manual vibration can be used successfully by the massage therapist to tone muscles by applying the technique at the muscle tendons for up to thirty seconds. Because vibration is used to “wake up” nerves, it is a good method to stimulate nerve activity. The nerves of the muscles around a joint also innervate the joint itself. Muscle pain is often interpreted by the client as joint pain and vice versa. Used specifically and purposefully, vibration is a great massage manipulation to shift joint pain perception. A variation of vibration known as shaking is a massage method that is effective in relaxing muscle groups or an entire limb. Shaking manipulations confuse the positional sensors, which causes the muscles to relax. The sensory input is too unorganized for the integrating systems of the brain to interpret, and going limp is the natural response in such situations. Shaking also warms and prepares the body for deeper bodywork. Shaking is sometimes classified as a vibration even though the application is very different. Shaking begins with lift and pull components while vibration begins with compression. Either a muscle group or a limb is grasped, lifted, and shaken. Shaking is not a manipulation to be used on the skin or superficial fascia, nor is it effective to use on the entire body. Rather, it is best applied to any large muscle groups that can be grasped and to synovial joints. Good areas for shaking include the upper trapezius and shoulder area, biceps and triceps groups, hamstrings, quadriceps, gastrocnemius, and in some instances the abdominals and the pectoralis muscles close to the axilla. The joints of the shoulders, hips, and extremities also respond well to shaking. The larger the muscle or joint, the more intense is the method. 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 this method. Another variation of vibration is known as rocking, a soothing and rhythmic form of shaking that has been used since the beginning of time to calm people. Rocking works through
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the vestibular system of the inner ear and feeds sensory input directly into the cerebellum. It is probable that the 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 is affected, initiating reflex nervous system mechanisms. Rocking is rhythmic and should be applied with a deliberate and full-body movement. Rocking involves the up-and-down and side-to-side movement of shaking, but there is no flick or throw-off 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 client’s rhythm can be sensed. At this point, the 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. Many reflex nervous system responses are elicited by the rocking of the body during effleurage, petrissage, and compression. 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, however, work on all the tissues through stimulation of the nervous systems, primarily the proprioceptors of the muscles and joints.
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 at a fast rate. The blows are directed downward to create a rhythmic compression of the tissue. Tapotement is divided into two classifications: light and heavy. The difference between light and heavy tapotement is 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 such as the pleura in the chest cavity. Tapotement, or percussion, 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. 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. In tapotement, two hands are 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. Heavy tapotement should not be done over the kidney area, or anywhere there is pain or discomfort. Proper methods are as follows:
Hacking. Applied with both wrists relaxed and the fingers spread, only the little fingers or the ulnar side of the hand strikes the surface in hacking. The other fingers hit each other with a springy touch. Hacking is used with the whole hand on the larger soft tissue areas such as the upper back and shoulders. Cupping. Fingers and thumbs are placed as if making a cup. The hands are turned over and the same action as hacking is done. Used on the anterior and
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posterior thorax, cupping is good for stimulation of the respiratory system and for loosening mucus.
Beating and pounding. These moves are done with a soft fist with knuckles down, or vertically with the ulnar side of the palm. Beating and pounding is done over large muscles such as the buttocks and heavy leg muscles. Slapping (splatting). The whole palm of the flattened hand makes contact with the body. This technique is good to use on the bottom of the feet. Tapping. The palmar surface of the fingers alternately taps the body area with light to medium pressure. This method is good around the joints, on the tendons, on the face and head, and along the spine.
Joint Movement
To understand joint movement, you must first understand the joint. Joint movement techniques focus on the synovial or freely movable joints of the body. To a lesser degree, the joints of the vertebral column, hand, and foot are also considered. Muscles do not directly influence these joints; they move through indirect muscle action. Joints allow us to move. Joint position and velocity receptors inform the central nervous system regarding where and how the body is positioned against gravity and how fast it is moving. This sensory data is the major determining factor for muscle tone patterns. Joint movement involves moving the jointed areas within the physiologic limits of range of motion of the client. Active joint movement means that the client moves the joint by active contraction of muscle groups. Active assisted movement means that both the client and therapist move the area. Passive joint movement occurs when the client’s muscles stay relaxed and the massage therapist moves the joint with no assistance from the client. Whether active or passive, joint movements are always done within the comfortable limits of range of motion of the client. The shape and fit of the bones at the joint determine anatomic barriers. Physiologic barriers are caused by the limits of range of motion imposed by protective nerve and sensory function. This type of barrier often displays itself as stiffness, pain, or a “catch.” When using joint movement techniques, it is important to remain within the physiologic barriers and to gently and slowly encourage the joint to increase the limits of the range of motion. When a normal joint is taken to its limit, there is usually still a bit more movement possible, a sort of springiness in the joint. This is called a soft end-feel. When there is abnormal restriction, the limit does not have this spring, but like a jammed door or drawer, the joint is fixed at the barrier, and any attempt to take it further is uncomfortable and distinctly “binding” or jamming, rather than springy. This is called a hard end-feel. When doing passive joint movement, feel for the soft or hard end-feel of the joint range of motion. When incorporating joint movement into the massage, follow these basic suggestions:
If possible, do active joint movement first. Assess range of motion by having the client move the area. Then have the client move the area against your stabilizing force to increase the intensity of the signals from the contracting muscles, which discharges the nervous system. Incorporate any or all of the previously discussed massage methods.
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Once the tissue is warm and the nervous system is relaxed, perform the passive range of motion / joint movement.
Summary
In general, massage manipulations and techniques either stimulate or inhibit a response. When thinking in terms of muscle, think of toning (causing it to contract) or relaxing (reduction of the neural stimulation causing contraction) the muscle. All massage methods use forms of external sensory information that can stimulate or inhibit body processes, depending on their use. Massage techniques that move through the skin to the underlying tissue tend to be more mechanical and will stimulate localized chemical responses. Massage techniques that stay within the skin and superficial fascial layer tend to have a more direct effect on the nervous system. Many sensory nerves are located in the skin. These methods also tend to stimulate the release of hormonal and other body chemicals that provide for a general systemic (whole body) effect. Massage techniques that move the body, causing muscles to contract and joint positions to change, deliver sensory input to the proprioceptors and are more reflexive in nature. Massage techniques that stretch (pull on) soft tissues are reflexive, mechanical, and chemical in their effect. The practitioner must also understand the movement to be applied to a particular part of the body. For example, light movements are applied over thin tissues or bony parts, heavy movements are indicated for thick tissues or fleshy parts, gentle movements are applied with a slow rhythm and are soothing and relaxing, and vigorous movements are applied in a quick rhythm and are stimulating. While applying the movements, the practitioner must pay close attention to the overall response of the client as well as the response of the tissue or body part to which the manipulation is being applied and adjust the application accordingly.
Questions for Discussion and Review: “Massage Movements and Techniques”
1. What is the first technique in developing a therapeutic relationship? 2. What factors must be considered as components in the application of massage techniques? 3. What is the direction of centrifugal movements? 4. What is the direction of centripetal movements? 5. What is meant by depth of pressure? 6. What are the variations of depth of pressure that can be used during a massage? 7. What is drag? 8. Where are light pressure movements used? 9. Where are heavy pressure movements used? 10. What are the variations of speed that can be used during a massage? 11. What is rhythm? 12. What are the effects of massage movements that have a gentle and slow rhythm? 13. What are the effects of massage movements that are vigorous and have a quick rhythm? 14. What is frequency? 15. What is duration? 16. What is effleurage? 17. What are the different variations of effleurage? 18. When is superficial gliding applied? 19. What are the benefits of superficial gliding? 20. What are the effects of superficial applications of effleurage? 21. What are the effects of deep applications of effleurage? 22. When is deep gliding most effective?
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23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. 58. 59. 60. 61. 62. 63. 64. 65. 66. 67. 68. 69. 70. 71. 72. 73. 74. 75.
What are the effects of deep gliding on the muscle and connective tissue? What are the effects of deep gliding on the circulation? Which direction does deep gliding usually follow? What should the practitioner be aware of when doing deep gliding? What is feather stroking? What is another name for feather stroking? How is feather stroking performed? What are the effects of feather stroking? What are the effects of slow, superficial gliding strokes? What are the effects of fast, superficial gliding strokes? What are the effects of a deeper gliding stroke at a slower rate? What is petrissage? What is the main purpose of petrissage? How is petrissage done? What is the effect of petrissage on the muscle tissue? What is the effect of petrissage on the tendons? What is skin-rolling? What are the benefits of skin-rolling? Where did compression come from? Where is ischemic compression performed? What are the effects of compression? Petrissage is used as a stimulating or relaxing technique? What is friction? What are the effects of friction? When is this massage technique contraindicated? Which direction is friction applied? What are the effects of friction on the connective tissues? What are the effects of combining friction with compression? What are the three basic variations of friction? What are three additional variations of friction? What is rolling? What is chucking? What is wringing? What is vibration? What is the effect of vibration on the nerves? What is shaking? What are the effects of shaking? How is shaking performed? What are some good areas for shaking? What is rocking? How does rocking work? What are the effects of rocking? What is tapotement? What are the two classifications of tapotement? What type of manipulation is tapotement? How does tapotement work? What are the five different methods of tapotement? What is hacking? Where is hacking done? What is cupping? Where is cupping done? What is beating and pounding? Where is beating and pounding done?
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76. 77. 78. 79. 80. 81. 82. 83. 84. 85. 86. 87. 88. 89. 90. 91. 92. 93. 94. 95. 96.
What is slapping? Where is slapping done? What is tapping? Where is tapping done? What are active joint movements? What are active assistive joint movements? What are passive joint movements? Describe what “soft end-feel” means. What type of joint movement should be done first with a client? When should passive range of motion be performed? What are the general effects of massage? What are the effects of massage techniques that move through the skin? What are the effects of massage techniques that stay within the skin and superficial layer? What are the effects of massage techniques that move the body? What are the effects of massage techniques that stretch soft tissues? Where should light movements be applied? Where should heavy movements be applied? How should gentle movements be applied? What are the effects of gentle movements? How should vigorous movements be applied? What are the effects of vigorous movements?
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