Massage Techniques
Introduction
There are Standards that apply in general to the performance of massage therapy techniques.
These Standards are addressed on this page. These "General" Standards are to be met in the performance of all techniques in massage therapy treatment.
Conditions:
Given that the client's treatment plan includes one or more massage therapy techniques.
Task:
Perform the technique(s) correctly and in such a way that they are well integrated in the treatment, and that the treatment plan is executed with the client's consent and is consistent with the principles of massage.
Standard
Quality / Interpersonal:
Do not use a technique, or continue its use, if the client indicates a preference not to use it.
Make the client aware that some techniques may be painful, depending on how they are applied and the condition being treated.
Treat within the client's pain tolerance, and you give the client the opportunity to inform you of his/her pain level within a mutually agreed upon range of acceptable pain.
Quality / Technical:
Four basic principles of massage are applied:
1) Superficial, deep, superficial
2) General, specific, general
3) Proximal, distal, proximal
4) Peripheral, central, peripheral
STROKING TECHNIQUE
Conditions:
Given that the client's treatment plan indicates the need for stroking technique.
Standard:
Quality / Technical:
Stroking is performed through client's covering or directly on the skin.
If the purpose of stroking is to achieve a relaxation effect the technique is soothing, slow, and even.
If the purpose of stroking is to achieve a stimulating effect, the technique is brisk.
Safety:
Stroking is not used or is modified if a contraindication to this technique exists.
ROCKING OR SHAKING TECHNIQUE
Conditions:
Given that the client's treatment plan indicates the need for rocking and/ or shaking technique.
Standard:
Quality / Technical:
Rock to create movement around a joint and shake to move the soft tissue.
Safety:
Treat within the client's agreed upon pain tolerance.
Take special precaution, based on your assessment, with any client who is prone to joint subluxation/dislocation, or joint disease, inflammation or effusion or compromised integrity of the adjoining soft tissue.
Rocking or shaking is not used or is modified if a contraindication to this technique exists.
EFFLEURAGE TECHNIQUE
Conditions:
Given that the client's treatment plan indicates the need for effleurage technique.
Standard:
Quality / Technical:
The direction of movement is generally towards the heart.
The movement is broad and general, and proportional to the part of the body being worked on.
Safety:
Effleurage is not used or is modified if a contraindication to this technique exists.
PETRISSAGE TECHNIQUE
Conditions:
Given that the client's treatment plan indicates the need for petrissage technique.
Standard:
Quality / Technical:
The tissues are compressed and released in a rhythmical fashion.
The tissue layers are kneaded and stretched relative to each other.
Safety:
Petrissage is not used or is modified if a contraindication to this technique exists.
FRICTION TECHNIQUE
Conditions:
Given that the client's treatment plan indicates the need for friction therapy.
Standard:
Quality / Technical:
The tissues are warmed and stretched before the technique is applied.
Your fingers do not glide over the client's skin.
Friction is performed specifically on the site of an adhesion or lesion.
Following the application of friction, the fibres are stretched.
Quality / Interpersonal:
Client is informed that friction may be painful.
Inquire as to the client's comfort with regard to the level of pressure and pain.
Stop or modify treatment immediately when the client indicates an unexpected increase in pain or a positive change in the tissue.
Safety:
Following the application of a friction technique where inflammation is a response, ice is applied to the friction site following the stretch.
Medication history is considered before applying frictions.
Friction is not used or is modified if a contraindication to this technique exists.
VIBRATION TECHNIQUE
Conditions:
Given that the client's treatment plan indicates the need for vibration technique.
Standard:
Quality / Technical:
Perform static vibrations, and the whole hand or part thereof is in continuous contact with the client's body without sliding over the client's skin.
Perform running vibrations, and the whole hand or part thereof is in continuous contact with the client's body with a slight glide over the client's skin.
Safety:
Vibration is not used or is modified if a contraindication to this technique exists.
TAPOTEMENT TECHNIQUE
Conditions:
Given that the client's treatment plan indicates the need for a tapotement technique.
Standard:
Quality / Technical:
The technique is percussive and rhythmic.
Perform light tapotement and hands are light and springy and do not create force below the skin surface.
Perform heavy tapotement while hands are firm and apply force below the skin surface.
Safety:
Heavy tapotement technique is not performed over any bony prominence, the kidneys, abdomen or any fragile tissue.
Tapotement is not used or is modified if a contraindication to this technique exists.
DEEP FASCIAL TECHNIQUE
Conditions:
Given that the client's treatment plan indicates the need for a deep fascial technique.
Standard:
Quality / Technical:
The technique engages fascia and results in increased mobility and flexibility of tissue.
The issues are warmed and stretched before and soothed after the technique is applied.
Quality / Interpersonal:
Inform the client that deep fascial techniques may be painful.
Inquire as to the client's comfort with regard to the level of pressure and pain.
Stop or modify treatment immediately when the client indicates an unexpected increase in pain or a positive change in the tissue.
Safety:
Medication history is considered before applying deep fascial techniques.
Deep fascial techniques are not used or are modified if a contraindication to these techniques exist.
MYO-FASCIAL TRIGGER POINTS
Identify Myo-Facial Trigger Points
Conditions:
Given the client's treatment plan indicates the possibility that trigger points may be present.
Task:
Identify myo-fascial trigger points.
Standard:
Quality / Technical:
Trigger points are identified correctly, as indicated by at least two of: local tenderness within a taut band of muscle local twitch response, and/or a client's report of referred pain tenderness, or autonomic phenomenon pattern.
Quality / Interpersonal:
Stop the assessment of trigger points immediately if the client requests.
TREAT MYO-FASCIAL TRIGGER POINTS
Conditions:
Given that a trigger point has been identified.
Standard:
Quality / Technical:
Treatment technique is applied until the client tells you the level of referred pain either decreases or is eliminated.
Discontinue the technique if the referred pain does not diminish.
So that following the treatment of the trigger point the treated muscle is stretched.
Quality / Interpersonal:
Client is informed that the treatment of myo-fascial trigger points may be painful.
Treat within the client's agreed upon pain tolerance.
Safety:
Treatment of trigger points is not used or is modified if a contraindication to this technique exists.
LOW-GRADE JOINT MOBILIZATION
(Sustained Grade I or II or Grade I or II Oscillations)
Conditions:
Given that the client’s treatment plan indicates a need to maintain joint ROM and/or decrease joint pain.
Standard:
Quality / Technical:
The joint is in a loose-pack position.
The joint is taken up to the elastic barrier but not beyond, within the client’s pain tolerance.
Safety:
Assess the joint for pain prior to treatment by using a gentle, controlled traction.
Treat the client within their agreed upon pain tolerance.
Perform a gentle traction where possible before doing any gliding movements.
Low-grade joint mobilization is not used or is modified if a contraindication to this technique exists.
HIGH-GRADE JOINT MOBILIZATION
(Sustained Grade II and or Oscillations III and IV Joint Mobilization)
Conditions:
Given that the client’s treatment plan indicates a need to increase inert tissue elongation through joint mobilization.
Standard:
Quality / Technical:
Tissues around the joint is warmed and stretched prior to joint mobilization.
The directions of mobilization are correct for that specific capsular pattern.
The joint is in a loose-pack position.
The joint is taken to the end of its physiological range of motion, and then slightly beyond the physiological range of motion, within the client's comfort level.
The accessory movement and physiological movements may be improved.
High velocity low amplitude thrust techniques are not used to the spine.
Safety:
Assess the joint for pain prior to treatment by using a gentle, controlled traction.
Treat within the client's agreed upon pain tolerance.
Take special precaution, based on the assessment, with any client who is prone to joint subluxation/dislocation, or joint disease, inflammation or effusion or compromised integrity of the adjoining soft tissue.
High-grade joint mobilization is not used or is modified if a contraindication to this technique exists.
STRETCH TECHNIQUE
Conditions:
Given that the client's treatment plan indicates the need for a stretch technique.
Standard:
Quality / Technical:
The soft tissue is lengthened within the client's pain tolerance.
The stretch is held without bouncing until there is a release in the tissue being stretched.
Safety:
Stretch technique is not used or is modified if a contraindication to this technique exists.
Do not stretch an unstable structure or tissue.
INTRA-ORAL TREATMENT
Conditions:
Given that the client's treatment plan indicates the need for intra-oral treatment.
Standard:
Quality / Technical:
Never treat past the larynx.
Quality / Interpersonal:
Set up a non-verbal signal from the client with regard to pain and comfort level.
Safety:
Use protective barriers for the entire hand while treating in the mouth.
Treatment is discontinued if the client indicates.
Intra-oral treatment is not used or is modified if a contraindication to this treatment exists.
BREAST MASSAGE
Conditions:
Given that breast massage is requested or clinically indicated prior to treatment, and that the client has consented to breast massage.
Clinical Indicators concerning the breast:
general drainage problems.
pre/post menstrual pain.
breast swelling and/or congestion.
discomforts of pregnancy and/or lactation.
blocked milk ducts (contraindicated if mastitis).
pre/post surgery including breast augmentation or reduction.
symptomatic relief of pain.
promotion of good quality scarring and relief of adhered/restrictive/painful scarring.
common benign breast conditions.
assistance with breast health.
discomfort from cancer treatment.
rehabilitation from cancer treatment.
Standard:
Quality / Technical & Interpersonal:
Do not touch the nipple and/or areola.
The breast tissue is uncovered only when it is being treated directly.
Breast massage is not performed or is modified if a contraindication to this treatment exists.
Safety:
Vigorous techniques are not used when breast implants are present.
Consent is obtained in accordance to public health safety.
CHEST WALL MASSAGE
Conditions:
Given that massage to structures of the chest wall has been requested or clinically indicated prior to treatment, and that the client has consented to the treatment plan.
Clinical Indicators concerning chest wall musculature, including but not limited to:
post-mastectomy.
rehabilitation after cancer treatment.
chronic respiratory conditions.
relief of muscular discomfort and/or pain.
supportive treatment of postural rebalancing.
scarring of the tissue of the chest wall.
Standard:
Quality / Technical:
The chest/breast is uncovered only with the prior and voluntary consent of the client.
Safety:
Structures of the chest wall are not treated or that treatment is modified if contraindications to treatment of this area exist.
HYDROTHERAPY
Conditions:
Given that the client's treatment plan indicates a need to use hydrotherapy.
Standard:
Quality / Technical & Interpersonal:
Describe to the client how the hydrotherapy application would be performed, including its intended effect and possible negative reactions.
Provide the client with an opportunity to ask questions.
Regularly observe the client's physical reactions and inquire as to the client's comfort.
Hydrotherapy treatment is pre-tested on a small area (patch test) if there is any concern about the client's ability to tolerate the temperature or type of application.
The size, intensity and duration of treatment is determined according to the client's general health status and indications in the case.
Provide the client with a rest period following large or intense applications.
Equipment manufacturer's specifications are followed correctly and a maintenance log is kept.
Equipment is cleaned and maintained.
Safety:
Applications used are not contraindicated due to the client's condition.
Applications are modified if necessary, due to the client's condition.
Regularly observe the client’s response to treatment and remain available for treatment alteration.
Medical history of the client indicates a high risk of any negative reaction, constant supervision is maintained.
If any negative reactions are identified, treatment is modified or stopped.
Hygienic conditions are maintained at all times.
CUPPING THERAPY
Promotes relaxation
Stimulates the parasympathetic nervous system
Encouraging deep breathing during cupping session and the client feeling the suction of each cup
Increases circulation
As the vacuum effect takes place, blood is drawn to the tissue that is rising within the cup increasing local circulation, then drains as the cups are removed clients will notice the warm sensation to the areas that were cupped.
Increases range of motion, when cups are placed around joints, blood is drawn to the area and warms the joint similar to an exercise warm up.
Decreases muscle tension, cups stretch the muscle and fascia as it rises into the cup.
Stimulating parasympathetic nervous system.
Breaks down fascial restrictions, scar tissue and adhesions.
Applying stationary cups or gliding cups (cupping massage)
Stretch to muscle and fascia and an increase of local circulation.
Encourages lymph drainage, lifts tissue to promote drainage of edema. Light cupping is used as with lymphatic drainage.
Safety:
Lymphedema, Hemophilia, high fever, acute inflammation, breast tissue of women, open wound, pregnancy, hernias, slipped disc, varicose vein, renal failure, cirrhosis, and diabetes.
