Various forms of massage, traction,
and manipulation have been used in medicine throughout the world for
several thousand years. Each modality represents an approach to
treatment of the musculoskeletal and other systems sought by a steadily
increasing number of people. While research on each of these modalities
continues, a long-standing variable, the concept of touch, unites them
all.
In the 1940s, Rene A. Spitz reported on foundling home infants who, otherwise healthy and well taken care of, failed to thrive and often died in the absence of being held or touched. Kunz and Krieger additionally defined and taught the principles behind the related concepts of healing touch and therapeutic touch in the 1970s. While there is no consensus on the complete physiology of massage, traction, or manipulation, it is generally accepted that there is more to these treatment approaches than just the interaction of mechanical forces and human anatomy. There is a long history of touch as a natural, essential component to healing and health maintenance.
Throughout history, massage has been woven into the cultural context of medicine. Massage may be the earliest and most primitive tool to treat pain.[1] Massage consists of Eastern and Western variants. In the West, the practice and popularity of massage has varied over time. In recent years, a previous decline in popularity of massage, probably related to technological advancements in medicine, has been reversed into a resurgence of interest. In the US, approximately $2-4 billion is spent annually on visits to massage therapists, which accounted for approximately 26% of the $11.7 billion spent on nontraditional healthcare in the 1990s.
The American people are pursuing massage in increasing numbers for various reasons (eg, relief of pain, relaxation, conditioning). While little doubt exists that massage is beneficial for certain conditions, additional research is needed to establish its profile of efficacy.
Massage consists primarily of hand movements, some of which may be traction based. Traction is defined as the act of drawing or pulling or as the application of a pulling force. Traction sometimes involves equipment but also can be applied manually. In addition, traction affects changes in the spinal column itself, with soft tissues only secondarily changed. Effects of massage, like those of traction, tend to be fairly nonspecific.
Most massage approaches involve a friction-reducing medium, so that the hands of the practitioner move along the patient's skin with minimal friction. Powders or oils often are used. Massage strokes also should be regular and cyclic. The rate of application for massage varies with the type of technique. In some approaches (eg, tapotement, percussion), the rate is several times per second, while in others it is much slower.
The amount of pressure depends upon technique and desired results. Light pressure may produce relaxation and relative sedation and may decrease spasm; breakdown of adhesions and intervention at a deeper tissue level may require heavier pressure. Treatment of edema and stretching of connective tissue generally requires intermediate amounts of pressure. Direction of massage often is centripetal to provide better mobilization of fluids toward the central circulation. The sequence of tissues treated often is performed in a centripetal fashion.
When muscles are treated, motions generally are kept parallel to muscle fibers. If the treatment goal is to reduce adhesions, shearing forces are circular or at least include cross-fiber components. The area to be treated with massage depends upon the condition being treated and may vary from a well-circumscribed area to treatment of contiguous areas.
Duration of treatment depends upon the area being treated, desired therapeutic goals, and patient tolerance. Wide variation exists regarding treatment duration, which often is guided by changes occurring to tissue during massage application. If massage is performed before other treatments, duration may be determined by the result needed in order to optimize the next treatment step. Duration of a massage therapy program can range from 1 week to months and depends upon verifiable therapeutic goals. Patients must be reexamined from time to time, depending upon diagnosis and therapeutic goals, to insure satisfactory progress.
In the 1940s, Rene A. Spitz reported on foundling home infants who, otherwise healthy and well taken care of, failed to thrive and often died in the absence of being held or touched. Kunz and Krieger additionally defined and taught the principles behind the related concepts of healing touch and therapeutic touch in the 1970s. While there is no consensus on the complete physiology of massage, traction, or manipulation, it is generally accepted that there is more to these treatment approaches than just the interaction of mechanical forces and human anatomy. There is a long history of touch as a natural, essential component to healing and health maintenance.
Throughout history, massage has been woven into the cultural context of medicine. Massage may be the earliest and most primitive tool to treat pain.[1] Massage consists of Eastern and Western variants. In the West, the practice and popularity of massage has varied over time. In recent years, a previous decline in popularity of massage, probably related to technological advancements in medicine, has been reversed into a resurgence of interest. In the US, approximately $2-4 billion is spent annually on visits to massage therapists, which accounted for approximately 26% of the $11.7 billion spent on nontraditional healthcare in the 1990s.
The American people are pursuing massage in increasing numbers for various reasons (eg, relief of pain, relaxation, conditioning). While little doubt exists that massage is beneficial for certain conditions, additional research is needed to establish its profile of efficacy.
Definition of basic massage concepts
Massage is a therapeutic manipulation of the soft tissues of the body with the goal of achieving normalization of those tissues. Massage can have mechanical, neurological, psychological, and reflexive effects. Massage can be used to reduce pain or adhesions, promote sedation, mobilize fluids, increase muscular relaxation, and facilitate vasodilation. Massage easily can be a preliminary treatment to manipulation; however, it clearly targets the health of soft tissues, while manipulation largely targets joint segments.Massage consists primarily of hand movements, some of which may be traction based. Traction is defined as the act of drawing or pulling or as the application of a pulling force. Traction sometimes involves equipment but also can be applied manually. In addition, traction affects changes in the spinal column itself, with soft tissues only secondarily changed. Effects of massage, like those of traction, tend to be fairly nonspecific.
Western massage
Western massage is the chief type of massage practiced in the United States today. Among the most common types of massage therapy are acupressure (Shiatsu), Rolfing, Swedish massage, reflexology, and release.[1] Western massage organizes variations of soft-tissue manual therapy into several categories. Pare of France introduced the basic terminology for Western massage to the United States. The essence of Western massage is use of the hands to apply mechanical forces to the skeletal muscles and skin, although the intent may be to affect either the more superficial tissues or the deeper ones. Types of basic Western massage are characterized by whether (1) the focus of pressure is moved by the hands gliding over the skin (ie, effleurage), (2) soft tissue is compressed between the hands or fingers and thumb (ie, pétrissage), (3) the skin or muscle is impacted with repetitive, compressive blows (ie, tapotement), or (4) shearing stresses arecreated attissueinterfaces below the skin (ie, deep friction massage). Forms of Western massage include the following:- Effleurage
- In this approach, the practitioner's hands glide across the skin overlying the skeletal muscle being treated.
- Oil or powder is incorporated to reduce friction; hand-to-skin contact is maintained throughout the massage strokes.
- Effleurage can be superficial or deep.
- Light strokes energize cutaneous receptors and act by neuroreflexive or vascular reflexive mechanisms, whereas deep stroke techniques mechanically mobilize fluids in the deeper soft-tissue structures.
- Deep stroking massage is performed in the direction of venous or lymphatic flow, whereas light stroking can be in any direction desired.
- Effleurage may be used to gain initial relaxation and patient confidence, occasionally to diagnose muscle spasm and tightness, and to provide contact of the practitioner's hands from one area of the body to another.
- The main mechanical effect of effleurage is to apply sequential pressure over contiguous soft tissues so that fluid is displaced ahead of the hands as tissue compression is accomplished.
- Pétrissage
- Pétrissage involves compression of underlying skin and muscle between the fingers and thumb of 1 hand or between the 2 hands.
- Tissue is squeezed gently as the hands move in a circular motion perpendicular to the direction of compression.
- The main mechanical effects are compression and subsequent release of soft tissues, reactive blood flow, and neuroreflexive response to flow.
- Lymphatic pump is a type of pétrissage done to the chest and rib cage of persons with respiratory compromise in order to draw lymph into the thoracic duct and venous circulation as a result of an alternating increase and decrease of pressure on the chest cavity.
- Tapotement
- This percussion-oriented massage involves striking soft tissue with repetitive blows, using both hands in a rhythmic, gentle, and rapid fashion.
- Numerous variations can be defined by the part of the hands making an impact with the body.
- The therapeutic effect of tapotement may result from compression of trapped air that occurs on impact.
- The overall effect of tapotement may be stimulatory; therefore, healthy persons with increased tolerance for this approach are more likely to find this type of massage useful.
- Deep friction
- Pressure is applied with the ball of the practitioner's thumb or fingers to the patient's skin and muscle.
- The main effect of deep friction massage is to apply shear forces to underlying tissues, particularly at the interface between 2 tissue types (eg, dermis-fascia, fascia-muscle, muscle-bone).
- Deep pressure keeps superficial tissues from shearing so that shear and force are directed at the deeper tissue surface interface.
- Deep friction massage frequently is used to prevent or slow adhesions of scar tissue
Eastern massage
Over the centuries, Eastern massage systems have been an integral part of the cultures where they are practiced. Systems for evaluation, diagnosis, and treatment generally are not grounded in conventional Western neurophysiology. Eastern massage includes, among other approaches, Shiatsu, a Japanese system based on traditional Chinese meridian theory with principles of Western science. The theory of Shiatsu is based upon the system of the 12 traditional Chinese meridians (ie, major channels) of the body in which the energy, life force, or Chi, circulates. Acupressure pressure points, situated along the course of channels, allow access to these channels. Acupressure applies massage forces, largely through digital pressure, to the same points treated with acupuncture needles. Imbalances of energy along the meridians are believed to cause disease and can be rectified by localized finger pressure.Reflexology and auriculotherapy
- These systems of massage share the meridian concept with Shiatsu.
- In these approaches, the meridians are believed to have whole body representations on the extremities (similar to the homunculus of the brain).
- The feet (in reflexology) and the ear (in auriculotherapy) have been mapped in detail.
Decongestive Lymphatic Therapy
Decongestive lymphatic therapy is the complex massage approach that includes manual lymphatic drainage (MLD) in addition to compressive bandages, exercises, and skin care. Manual lymphatic drainage consists of gentle massage in the treatment of lymphedema. Proximal areas are treated first to prevent a damming effect; the treatment is thought to stretch the lymphatic collectors and to stimulate the drainage system. The massage is followed by the application of compressive bandages and is incorporated into a complete self-care program.Massage technique
The practitioner controls several variables of massage, including milieu. Actual application of treatment includes rhythm, rate, pressure, direction, and duration.Most massage approaches involve a friction-reducing medium, so that the hands of the practitioner move along the patient's skin with minimal friction. Powders or oils often are used. Massage strokes also should be regular and cyclic. The rate of application for massage varies with the type of technique. In some approaches (eg, tapotement, percussion), the rate is several times per second, while in others it is much slower.
The amount of pressure depends upon technique and desired results. Light pressure may produce relaxation and relative sedation and may decrease spasm; breakdown of adhesions and intervention at a deeper tissue level may require heavier pressure. Treatment of edema and stretching of connective tissue generally requires intermediate amounts of pressure. Direction of massage often is centripetal to provide better mobilization of fluids toward the central circulation. The sequence of tissues treated often is performed in a centripetal fashion.
When muscles are treated, motions generally are kept parallel to muscle fibers. If the treatment goal is to reduce adhesions, shearing forces are circular or at least include cross-fiber components. The area to be treated with massage depends upon the condition being treated and may vary from a well-circumscribed area to treatment of contiguous areas.
Duration of treatment depends upon the area being treated, desired therapeutic goals, and patient tolerance. Wide variation exists regarding treatment duration, which often is guided by changes occurring to tissue during massage application. If massage is performed before other treatments, duration may be determined by the result needed in order to optimize the next treatment step. Duration of a massage therapy program can range from 1 week to months and depends upon verifiable therapeutic goals. Patients must be reexamined from time to time, depending upon diagnosis and therapeutic goals, to insure satisfactory progress.
No comments :
Post a Comment