Therapeutic Sports Massage

1. Therapeutic Sports Massage Jennifer Doherty-Restrepo, ATC, LAT Entry-Level Athletic Training Education Program PET 4995: Therapeutic Modalities

2. Physiologic Effects of Massage • Mechanical stimulation of tissues by rhythmically applied pressure and stretching • Effects of massage may be either • ___________,or • ___________ • Effects differ depending on method utilized, pressure exerted, and duration of massage

3. Physiologic Effects of Massage • ___________ • Effects sensory and motor nerves locally • Elicits some central nervous system response (ie: sedation) • ___________ • Makes mechanical or histological changes in myofascial structures through direct force applied superficially

4. Reflexive Effects • Attempts to exert effects through ______ and superficial connective tissues • Contact stimulates _________ receptors • Reflex mechanism is believed to be an autonomic nervous system phenomenon • The reflex stimulus causes • Sedation, • Relieves tension, and • Increases blood flow

5. Reflexive Effects cont. • Effects on Pain • Modulates pain through Gate Control & -Endorphins theories • Effects on Circulation • Increases blood and lymphatic flow • Effects on Metabolism • Does not alter general metabolism • Increases fresh blood and oxygen to area • Assists in removal of lactic acid

6. Mechanical Effects • Techniques which stretch a muscle, elongate fascia, or mobilize soft tissue adhesions/restrictions • Always accompanied by some reflex effects • As mechanical stimulus becomes more effective, reflex stimulus becomes less effective • Directed at deeper tissues, such as adhesions or restrictions in muscle, tendons, and fascia.

7. Mechanical Effects • Effects on Muscle • Mechanical stretching of intramuscular connective tissue to relieve pain and discomfort associated with myofascial trigger points • Increases blood flow to skeletal muscle • Slows muscle atrophy following injury • Increases range of motion • Does not increase strength or muscle tone

8. Mechanical Effects cont. • Effects on Skin • Increases skin temperature • Increases sweating • Decreases skin resistance to galvanic current • Mechanically loosens adhesions and softens scar tissue • Stretches and breaks down fibrous scar tissue • Breaks down adhesions between skin and subcutaneous tissue

9. Psychologic Effects of Massage • Psychologic effects of massage can be as beneficial as physiologic effects • ” ___________" modality where patients feel as if someone is helping them

10. Treatment Considerations and Guidelines • Knowledge of ___________ is essential • Understanding of existing pathology • Thorough knowledge of massage principles

11. Positioning of Clinician • Prevent ___________ • Permit free movement of arms, hands, and body • Evenly distribute weight by shifting from one foot to the other • Fit your hands to the contour of area being treated • Hands should be clean, warm, dry, and soft

12. Treatment Techniques • Pressure regulation • Determined by the type and amount of tissue present and patient's condition • Rhythm • Must be steady and even • Strokes should overlap • Duration • Depends on the pathology, size of the area being treated, speed of motion, age, size, and condition

13. Treatment Techniques • Swelling • Begin proximally to facilitate lymphatic flow • “___________“ • Body part may be elevated if necessary • Direction of forces should parallel muscle fibers • Make sure patient is warm and in a comfortable, relaxed position • Massage should never be ___________

14. Treatment Techniques • Sufficient lubricant should be used • Begin with superficial stroking to spread lubricant • Begin and end with ___________ • Pressure should be in line with venous flow followed by a return stroke

15. Equipment Set Up • Table • Linens and pillows • Lubricant • Should be absorbed slightly by skin but does not make it slippery • Combination of one part beeswax to three parts coconut oil • Other types of lubricants that may be used are olive oil, mineral oil, cocoa butter, hydrolanolin, analgesic creams, alcohol, and powder

16. Preparation of Patient • Patient should be in a relaxed, comfortable position • Part involved in treatment must be adequately supported • Prone, supine, seated • Patient should appropriately draped

17. Hoffa Massage • Classical massage technique which uses a variety of superficial strokes • Effleurage • Petrissage • Tapotment • Vibration

18. Effleurage • Any stroke that glides over skin without attempting to move deep muscles • Hands are molded to treatment area • Apply constant pressure moving toward _______ • Lighter pressure applied on the return stroke Every massage begins and ends with effleurage!

19. Effleurage cont. • Moderate pressure according to patient and condition • Deep stroking is a form of effleurage, except it is given with more pressure to produce a mechanical effect • Increases venous and lymphatic return • Increases circulation to skin surface

20. Petrissage • Kneading manipulations • Muscles are gently lifted, rolled, and released • Pressure is applied intermittently • Hands may remain stationary or move along length of muscle or limb

21. Petrissage cont. • Increases venous and lymphatic return • Removes metabolic waste products • Breaks up adhesions between skin and underlying tissue

22. Tapotment • Percussion massage • Series of rapid, brisk blows • Increases circulation and blood flow • Stimulates peripheral nerve endings

23. Tapotment cont. • Hacking

24. Tapotment cont. • Hacking • Slapping

25. Tapotment cont. • Hacking • Slapping • Beating

26. Tapotment cont. • Hacking • Slapping • Beating • Tapping

27. Tapotment cont. • Hacking • Slapping • Beating • Tapping • Clapping or cupping

28. Vibration • Shaking massage • Tremulous movement made by hand or fingers placed firmly against a body part • Rhythmical trembling movement will come from ___________ • Hands should remain in contact with the body part

29. Transverse Friction Massage • Technique used for treating chronic tendon inflammation or connective tissue adhesions • Stimulates ______________________ to progress healing process • Apply small circular motions penetrating to deeper tissues • Apply strong pressure in ___________ direction to fibers for 7 to 10 minutes every other day

30. Acupresure and Myofascial Trigger Point Massage • Acupressure points are based on ancient Chinese art of acupuncture • Myofascial trigger points found in… • Muscle and tendon myofascia • Ligaments and capsules surrounding joints • Periosteum • Acupressure points and myofascial trigger points are similar

31. Acupresure and Myofascial Trigger Point Massage • Pain results due to inflammatory response following direct trauma or overuse • Pain usually referred to areas which follow a specific pattern • Stimulation of these points has been demonstrated to result in pain relief

32. Acupressure Massage Techniques • Locate points from chart • Use fingers, or elbow, to apply small friction-like circular motions • Amount of pressure applied should be intense and painful • Patient reports a dulling or numbing effect • Treatment times range from 1-5 minutes at several points

33. Myofascial Release • Also called soft tissue mobilization • Techniques used to relieve soft tissue from abnormal grip of tight fascia • Myofascial restrictions are unpredictable and may occur in many different planes and directions • Based on localizing restriction and moving into the direction of the restriction • Myofascial manipulation is subjective and relies heavily on the experience of the clinician

34. Myofascial Release Technique • Protecting the clinician’s hands • Use fist or elbow if necessary • Use limited lubricant • Avoid slipping of hands on the skin • Positoning of the patient is critical • Maximize effects of treatment

35. Increase coordination Decrease pain Decrease neuromuscular excitibility Stimulate circulation Facilitate healing Restore joint mobility Remove lactic acid Alleviate muscle cramps Increase blood flow Increase venous return Retard muscle atrophy Increase range of motion Edema Myofascial trigger points Stretching scar tissue Indications For Massage

36. Adhesions Muscle spasm Myositis Bursitis Fibrositis Tendinitis Revascularization Raynaud's disease Intermittent claudication Dysmenorrhea Headaches Migraines Indications For Massage

37. Arteriosclerosis Thrombosis Embolism Severe varicose veins Acute phlebitis Cellulitis Synovitis Abscesses Skin infections Cancers Acute inflammatory conditions Contraindications For Massage